Provider Demographics
NPI:1982693198
Name:SPECK, EUGENE LEWIS (MD PH D)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:LEWIS
Last Name:SPECK
Suffix:
Gender:M
Credentials:MD PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 780
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:702-737-0740
Mailing Address - Fax:702-737-1402
Practice Address - Street 1:3006 S MARYLAND PKWY
Practice Address - Street 2:SUITE 780
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2218
Practice Address - Country:US
Practice Address - Phone:702-737-0740
Practice Address - Fax:702-737-1402
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3968207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002626Medicaid
NVC49597Medicare UPIN
NV11WCCBX01Medicare ID - Type Unspecified