Provider Demographics
NPI:1669488185
Name:LEE, RICHARD SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 FOX SPRINGS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-238-8888
Mailing Address - Fax:702-946-5000
Practice Address - Street 1:3960 HOWARD HUGHES PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-5972
Practice Address - Country:US
Practice Address - Phone:702-990-3664
Practice Address - Fax:702-946-5000
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26538204D00000X
NV63812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260536800Medicaid
FLD67283Medicare UPIN
FL79373ZMedicare ID - Type Unspecified