MEDICARE: EUGENE G. PORRECA, MD., LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	5987	NV
2	208600000X	Surgery Physician	5987	NV

General Provider Information

NPI Number	:	1710158001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE G. PORRECA, MD., LLP

Provider Business Mailing Address
First Line	:	2655 BOX CANYON DR
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1119
Country	:	US
Telephone Number	:	702-869-4554
Fax Number	:	702-796-9225

Provider Business Practice Location Address
First Line	:	2655 BOX CANYON DR
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1119
Country	:	US
Telephone Number	:	702-869-4554
Fax Number	:	702-796-9225

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. EUGENE G PORRECA
Credential	:	M.D.
Telephone Number	:	702-869-4554

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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