Provider Demographics
NPI:1154313112
Name:VAN DUUREN, ANTON (MD)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:VAN DUUREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 THE VILLAGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2742
Mailing Address - Country:US
Mailing Address - Phone:828-631-1960
Mailing Address - Fax:828-586-3489
Practice Address - Street 1:70 THE VILLAGE OVERLOOK
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2742
Practice Address - Country:US
Practice Address - Phone:828-631-1960
Practice Address - Fax:828-586-3489
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900372207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12221OtherBC/BS
NC1163386OtherCIGNA
NC8912221Medicaid
NC8912221Medicaid
NC12221OtherBC/BS