Provider Demographics
NPI:1225027295
Name:SERFUSTINI, ANTHONY BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:BARRY
Last Name:SERFUSTINI
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 1:501 S RANCHO DR
Mailing Address - Street 2:STUITE I-65
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4861
Mailing Address - Country:US
Mailing Address - Phone:702-733-7855
Mailing Address - Fax:702-731-6918
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:SUITE I-65
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-733-7855
Practice Address - Fax:702-731-6918
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2851207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC96556Medicare UPIN