Provider Demographics
NPI:1861470692
Name:GORCZYCA, RAYMOND F (PA-C)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:F
Last Name:GORCZYCA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 S. RAINBOW BLVD
Mailing Address - Street 2:SUITE 282
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1895
Mailing Address - Country:US
Mailing Address - Phone:702-737-3808
Mailing Address - Fax:702-737-7364
Practice Address - Street 1:5320 S. RAINBOW BLVD
Practice Address - Street 2:SUITE 282
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1895
Practice Address - Country:US
Practice Address - Phone:702-737-3808
Practice Address - Fax:702-737-7364
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV374363A00000X
NVPA374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002402306Medicaid
PA374BMedicare UPIN
NV002402306Medicaid