MEDICARE: FRED DOELEONG LEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	NV5204	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790767895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED DOELEONG LEE MD

Provider Business Mailing Address
First Line	:	2251 N RAMPART BLVD
Second Line	:	338
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7640
Country	:	US
Telephone Number	:	702-733-6263
Fax Number	:	702-733-1796

Provider Business Practice Location Address
First Line	:	400 SHADOW LN
Second Line	:	SUITE 207
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4363
Country	:	US
Telephone Number	:	702-384-5400
Fax Number	:	702-384-0648

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/09/2010

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Directions to “ FRED DOELEONG LEE MD” Practice Location

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