Provider Demographics
NPI:1891752176
Name:ANSON, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:ANSON
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: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:702-948-8897
Mailing Address - Fax:702-549-3178
Practice Address - Street 1:8530 W SUNSET RD
Practice Address - Street 2:SUITE 250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2224
Practice Address - Country:US
Practice Address - Phone:702-851-0792
Practice Address - Fax:702-851-0797
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
NV8076207T00000X
AZ27062207T00000X
UT357661-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV140006092OtherRAILROAD MEDICARE
NV1891752176Medicaid
AZP00089608OtherMEDICARE RAILROAD
AZ133710Medicaid
NVDL024ZOtherMEDICARE PTAN
NVF37307Medicare UPIN
AZ133710Medicaid
NV30307Medicare PIN
NVDL024ZOtherMEDICARE PTAN