Provider Demographics
NPI:1194055442
Name:DUKE FORAGE ANSON NEUROSURGICAL LLP
Entity type:Organization
Organization Name:DUKE FORAGE ANSON NEUROSURGICAL LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:ADDISON
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-896-0940
Mailing Address - Street 1:861 CORONADO CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3992
Mailing Address - Country:US
Mailing Address - Phone:702-896-0940
Mailing Address - Fax:702-896-6173
Practice Address - Street 1:861 CORONADO CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3992
Practice Address - Country:US
Practice Address - Phone:702-896-0940
Practice Address - Fax:702-896-6173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8979207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194055442Medicaid
NVDI308AMedicare PIN