MEDICARE: BRIAN E 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	207R00000X	Internal Medicine Physician	12072	NV
2	208VP0000X	Pain Medicine Physician	12072	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	:	1881768596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN E LEE MD

Provider Business Mailing Address
First Line	:	PO BOX 621406
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89162-1406
Country	:	US
Telephone Number	:	702-434-6336
Fax Number	:	702-436-7912

Provider Business Practice Location Address
First Line	:	4409 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5029
Country	:	US
Telephone Number	:	702-434-6336
Fax Number	:	702-436-7912

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	04/13/2011

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Directions to “ BRIAN E LEE MD” Practice Location

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