Individual
THEODORE POTRUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2123 CIVIC CENTER DR, NORTH LAS VEGAS, NV 89030-6327
(702) 333-1110
(702) 685-0744
Mailing address
2123 CIVIC CENTER DR, NORTH LAS VEGAS, NV 89030-6327
(702) 333-1110
(702) 685-0744
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
3310
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V50306
MEDICARE PTAN
NV
Enumeration date
05/23/2006
Last updated
03/06/2018
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