Organization
THEODORE POTRUCH, MD
Active
Other names
BreastCare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE POTRUCH MD (DIRECTOR)
(702) 382-2273
Entity
Organization
Contact information
Practice address
2020 GOLDRING AVE, #206, LAS VEGAS, NV 89106-4000
(702) 382-2273
(702) 385-9956
Mailing address
2020 GOLDRING AVE, #206, LAS VEGAS, NV 89106-4000
(702) 382-2273
(702) 385-9956
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0022702550
—
NV
01
—
NV2969
BCBS
NV
Enumeration date
02/07/2007
Last updated
01/15/2008
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