Provider Demographics
NPI:1700882859
Name:ANDERSON, RICHARD HOWARD (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HOWARD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 1ST CAPITOL DR
Mailing Address - Street 2:STE 390
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2852
Mailing Address - Country:US
Mailing Address - Phone:636-949-5760
Mailing Address - Fax:636-949-0729
Practice Address - Street 1:330 1ST CAPITOL DR
Practice Address - Street 2:STE 390
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2852
Practice Address - Country:US
Practice Address - Phone:636-949-5760
Practice Address - Fax:636-949-0729
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8N732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO17143OtherBLUE CROSS BLUE SHIELD
222446OtherHEALTHLINK
222446OtherHEALTHLINK
00201189Medicare ID - Type Unspecified