Provider Demographics
NPI:1790767895
Name:LEE, FRED DOELEONG (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:DOELEONG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2251 N RAMPART BLVD
Mailing Address - Street 2:338
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7640
Mailing Address - Country:US
Mailing Address - Phone:702-733-6263
Mailing Address - Fax:702-733-1796
Practice Address - Street 1:400 SHADOW LN
Practice Address - Street 2:SUITE 207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4363
Practice Address - Country:US
Practice Address - Phone:702-384-5400
Practice Address - Fax:702-384-0648
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2010-08-09
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Provider Licenses
StateLicense IDTaxonomies
NVNV5204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002733Medicaid
NV002002733Medicaid