Provider Demographics
NPI:1972596336
Name:DURAN, ANTHONY J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:DURAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ANTONIO
Other - Middle Name:J
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1900 HOT SPRINGS BLVD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3481
Mailing Address - Country:US
Mailing Address - Phone:505-425-3718
Mailing Address - Fax:
Practice Address - Street 1:1900 HOT SPRINGS BLVD.
Practice Address - Street 2:SUITE D
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3481
Practice Address - Country:US
Practice Address - Phone:505-425-3718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM80-PA005363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70562Medicaid