MEDICARE: DR. DUNCAN E ANDERSON PSYD, LP

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	LP3430	MN

General Provider Information

NPI Number	:	1760480560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUNCAN E ANDERSON PSYD, LP

Provider Business Mailing Address
First Line	:	200 4TH AVE W
Second Line	:	GOVERNMENT CENTER RM 300
City	:	SHAKOPEE
State	:	MN
Zip	:	55379-1220
Country	:	US
Telephone Number	:	952-496-8567
Fax Number	:	952-496-8355

Provider Business Practice Location Address
First Line	:	200 4TH AVE W
Second Line	:	GOVERNMENT CENTER RM 300
City	:	SHAKOPEE
State	:	MN
Zip	:	55379-1220
Country	:	US
Telephone Number	:	952-496-8567
Fax Number	:	952-496-8355

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/09/2007

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