MEDICARE: DR. BRUCE DOUGLAS CASEY PH. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1048	CO

General Provider Information

NPI Number	:	1275662991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE DOUGLAS CASEY PH. D.

Provider Business Mailing Address
First Line	:	5277 MANHATTAN CIR
Second Line	:	SUITE110
City	:	BOULDER
State	:	CO
Zip	:	80303-8201
Country	:	US
Telephone Number	:	303-543-5783
Fax Number	:	303-543-5782

Provider Business Practice Location Address
First Line	:	5277 MANHATTAN CIR
Second Line	:	SUITE110
City	:	BOULDER
State	:	CO
Zip	:	80303-8201
Country	:	US
Telephone Number	:	303-543-5783
Fax Number	:	303-543-5782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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