Provider Demographics
NPI:1871562652
Name:PORRECA, EUGENE G (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:G
Last Name:PORRECA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9030 W SAHARA AVE
Mailing Address - Street 2:#550
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5744
Mailing Address - Country:US
Mailing Address - Phone:702-869-4554
Mailing Address - Fax:702-228-5653
Practice Address - Street 1:7106 SMOKE RANCH RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-869-4554
Practice Address - Fax:702-796-9225
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV5987208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV770589284OtherTAX ID
NV002019002Medicaid
NV770003058OtherRR
NVB34877Medicare UPIN
NVV36582Medicare ID - Type Unspecified