Provider Demographics
NPI:1982818076
Name:BRIAN E LEE MD LTD
Entity Type:Organization
Organization Name:BRIAN E LEE MD LTD
Other - Org Name:SOUTHERN NEVADA INTERNISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-434-6336
Mailing Address - Street 1:PO BOX 621406
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89162-1406
Mailing Address - Country:US
Mailing Address - Phone:702-434-6336
Mailing Address - Fax:702-436-7912
Practice Address - Street 1:4409 S PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5029
Practice Address - Country:US
Practice Address - Phone:702-434-6336
Practice Address - Fax:702-436-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12072207R00000X
208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512872Medicaid
NVV104417Medicare PIN
NV104417Medicare PIN