Provider Demographics
NPI:1992742118
Name:ANDERS, DEREK (DPM)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:ANDERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 N BUFFALO DR
Mailing Address - Street 2:STE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0376
Mailing Address - Country:US
Mailing Address - Phone:702-242-3870
Mailing Address - Fax:702-242-3873
Practice Address - Street 1:341 N BUFFALO DR
Practice Address - Street 2:STE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0376
Practice Address - Country:US
Practice Address - Phone:702-242-3870
Practice Address - Fax:702-242-3873
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDPM9501213ES0000X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU58326Medicare UPIN
NV4337690001Medicare NSC
NVV32474Medicare ID - Type Unspecified