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Individual

LUCAS PORTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
2680 CRIMSON CANYON DR, LAS VEGAS, NV 89128-0841
(208) 814-5075
Mailing address
2020 PALOMINO LN STE 110, LAS VEGAS, NV 89106-4892
(702) 474-7200
(702) 474-0009

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT-569
ID
363A00000X
Physician Assistant
Primary
PA2514
NV
363A00000X
Physician Assistant

Other

Enumeration date
11/06/2017
Last updated
12/03/2021
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