MEDICARE: DR. EUGENE G PORRECA M.D.

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	208600000X	Surgery Physician	5987	NV
2	2086S0129X	Vascular Surgery Physician	5987	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	770589284	OTHER	NV	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	770003058	OTHER	NV	RR

General Provider Information

NPI Number	:	1871562652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE G PORRECA M.D.

Provider Business Mailing Address
First Line	:	9030 W SAHARA AVE
Second Line	:	#550
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5744
Country	:	US
Telephone Number	:	702-869-4554
Fax Number	:	702-228-5653

Provider Business Practice Location Address
First Line	:	7106 SMOKE RANCH RD
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-869-4554
Fax Number	:	702-796-9225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	06/26/2012

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Directions to “ DR. EUGENE G PORRECA M.D.” Practice Location

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