Healthcare Provider Details

I. General information

NPI: 1619934916
Provider Name (Legal Business Name): DEREK A DUKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 CORONADO CENTER DR SUITE 200
HENDERSON NV
89052
US

IV. Provider business mailing address

PO BOX 95306
LAS VEGAS NV
89193-5306
US

V. Phone/Fax

Practice location:
  • Phone: 702-896-0940
  • Fax: 702-896-6173
Mailing address:
  • Phone: 702-896-0940
  • Fax: 702-896-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number8979
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number36583
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: