Healthcare Provider Details

I. General information

NPI: 1407830458
Provider Name (Legal Business Name): EUGENE GERARD MARCINIAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 W AMADOR AVE STE A
LAS CRUCES NM
88005-2739
US

IV. Provider business mailing address

999 W AMADOR AVE STE A
LAS CRUCES NM
88005-2739
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-5482
  • Fax: 575-525-3542
Mailing address:
  • Phone: 575-527-5482
  • Fax: 575-525-3542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2000237
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: