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NPI Code Detail

MEDICARE: DR. KEITH J ANDERSEN PH.D.

MEDICARE: DR. KEITH J ANDERSEN 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
1103TB0200XCognitive & Behavioral Psychologist14114CA

General Provider Information

NPI Number : 1275558694
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH J ANDERSEN PH.D.
Provider Business Mailing Address
First Line : PO BOX 873
Second Line :
City : BISHOP
State : CA
Zip : 93515-0873
Country : US
Telephone Number : 760-873-6712
Fax Number : 760-873-6712
Provider Business Practice Location Address
First Line : 152 PIONEER LN STE H
Second Line :
City : BISHOP
State : CA
Zip : 93514-2563
Country : US
Telephone Number : 760-873-6712
Fax Number : 760-873-6712
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 07/08/2007

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