Healthcare Provider Details

I. General information

NPI: 1992742118
Provider Name (Legal Business Name): DEREK ANDERS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 N BUFFALO DR STE A
LAS VEGAS NV
89145-0376
US

IV. Provider business mailing address

341 N BUFFALO DR STE A
LAS VEGAS NV
89145-0376
US

V. Phone/Fax

Practice location:
  • Phone: 702-242-3870
  • Fax: 702-242-3873
Mailing address:
  • Phone: 702-242-3870
  • Fax: 702-242-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberDPM9501
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPM9501
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM9501
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: