Provider Demographics
NPI:1649777608
Name:DUKE FORAGE ANSON NEUROSURGICAL LLP
Entity Type:Organization
Organization Name:DUKE FORAGE ANSON NEUROSURGICAL LLP
Other - Org Name:THE SPINE AND BRAIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER OWNER & PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-896-0940
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:702-851-0792
Mailing Address - Fax:702-851-0797
Practice Address - Street 1:8530 W SUNSET RD STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2245
Practice Address - Country:US
Practice Address - Phone:702-851-0792
Practice Address - Fax:702-851-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194055442Medicaid