Provider Demographics
NPI:1376550434
Name:LIBBY, EUGENE (DO, PC)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:LIBBY
Suffix:
Gender:M
Credentials:DO, PC
Other - Prefix:DR
Other - First Name:EUGENE
Other - Middle Name:P
Other - Last Name:LIBBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1800 W. CHARLESTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:702-740-5328
Practice Address - Street 1:2231 W. CHARLESTON BLVD.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-383-2663
Practice Address - Fax:702-383-2682
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV587207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019270Medicaid
NVVDO587AMedicare PIN
NVEG774YMedicare PIN
F96588Medicare UPIN