Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 10373 | NV |
Y | 207PE0004X | Emergency Medical Services | 10373 | NV |
NPI | 1205295276 |
---|---|
Provider Name | Dr. Bradford Lee |
First Address | Reno, NV 89502-4104 |
Second Address | Reno, NV 89502-4104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2016 |
Last Update Date | 18/02/2016 |