Provider Demographics
NPI:1669589735
Name:LEE, SAMUEL (MD)
Entity type:Individual
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First Name:SAMUEL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1155 MILL ST
Mailing Address - Street 2:MS M-14
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-8041
Practice Address - Street 1:6130 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-6060
Practice Address - Country:US
Practice Address - Phone:775-982-1000
Practice Address - Fax:775-982-8041
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2025-01-27
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Provider Licenses
StateLicense IDTaxonomies
NV25125207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1669589735Medicaid
TX172732301Medicaid