MEDICARE: DR. GARRY R. LEE M.D.

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	207Q00000X	Family Medicine Physician	NV-8288	NV
2	207Q00000X	Family Medicine Physician	35-06-2966-	OH

General Provider Information

NPI Number	:	1881631851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRY R. LEE M.D.

Provider Business Mailing Address
First Line	:	2610 W HORIZON RIDGE PKWY
Second Line	:	SUITE 100
City	:	HENDERSON
State	:	NV
Zip	:	89052-2869
Country	:	US
Telephone Number	:	702-938-0190
Fax Number	:	702-938-0189

Provider Business Practice Location Address
First Line	:	2610 W HORIZON RIDGE PKWY
Second Line	:	SUITE 100
City	:	HENDERSON
State	:	NV
Zip	:	89052-2869
Country	:	US
Telephone Number	:	702-938-0190
Fax Number	:	702-938-0189

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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