Provider Demographics
NPI:1881631851
Name:LEE, GARRY R (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:R
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2610 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2869
Mailing Address - Country:US
Mailing Address - Phone:702-938-0190
Mailing Address - Fax:702-938-0189
Practice Address - Street 1:2610 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2869
Practice Address - Country:US
Practice Address - Phone:702-938-0190
Practice Address - Fax:702-938-0189
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVNV-8288207Q00000X
OH35-06-2966-207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG70312Medicare UPIN
NV34766Medicare ID - Type Unspecified