Provider Demographics
NPI:1952372492
Name:LEE, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LEE
Suffix:
Gender:M
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 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-838-8265
Mailing Address - Fax:702-804-3788
Practice Address - Street 1:7061 GRAND MONTECITO PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0287
Practice Address - Country:US
Practice Address - Phone:702-750-3800
Practice Address - Fax:702-750-3808
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV080173085OtherRAILROAD MEDICARE
NV3102774Medicaid
NV2018774Medicaid
NVFL591ZMedicare PIN
NV3102774Medicaid
NV35075Medicare PIN