Provider Demographics
NPI:1013407642
Name:LEE, COLTON TY (MD)
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:TY
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8930 W SUNSET RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5013
Mailing Address - Country:US
Mailing Address - Phone:702-258-7788
Mailing Address - Fax:702-258-7877
Practice Address - Street 1:8930 W SUNSET RD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5013
Practice Address - Country:US
Practice Address - Phone:702-757-4724
Practice Address - Fax:702-258-7877
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV23835208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery