Provider Demographics
NPI:1679643399
Name:LEE, DEANNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
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:PO BOX 82171
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-2171
Mailing Address - Country:US
Mailing Address - Phone:702-876-5400
Mailing Address - Fax:702-368-2308
Practice Address - Street 1:2950 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6244
Practice Address - Country:US
Practice Address - Phone:702-876-5400
Practice Address - Fax:702-368-2308
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE74444Medicare UPIN
NVV101772Medicare ID - Type Unspecified