Healthcare Provider Details

I. General information

NPI: 1700882859
Provider Name (Legal Business Name): RICHARD HOWARD ANDERSON M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 1ST CAPITOL DR STE 390
SAINT CHARLES MO
63301-2852
US

IV. Provider business mailing address

330 1ST CAPITOL DR STE 390
SAINT CHARLES MO
63301-2852
US

V. Phone/Fax

Practice location:
  • Phone: 636-949-5760
  • Fax: 636-949-0729
Mailing address:
  • Phone: 636-949-5760
  • Fax: 636-949-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR8N73
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: