Provider Demographics
NPI:1407837966
Name:PORRO VIZCARRA, RAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:A
Last Name:PORRO VIZCARRA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 READS WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1630
Mailing Address - Country:US
Mailing Address - Phone:302-709-4709
Mailing Address - Fax:302-709-4551
Practice Address - Street 1:801 MIDDLEFORD ROAD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973
Practice Address - Country:US
Practice Address - Phone:302-629-6611
Practice Address - Fax:302-628-6313
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-12-02
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0011728207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE04126Medicare UPIN