Provider Demographics
NPI:1619934916
Name:DUKE, DEREK A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:A
Last Name:DUKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 95306
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-5306
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
Practice Address - Country:US
Practice Address - Phone:702-896-0940
Practice Address - Fax:702-896-6173
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8979207T00000X
AZ36583207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV140006030OtherRAILROAD MEDICARE
NV1619934916Medicaid
AZ468662Medicaid
AZ468662Medicaid
NV32023Medicare PIN
AZ468662Medicaid