Active NPI
Richard D Back, PH.D
- Clinical Neuropsychologist
- Fayetteville, AR
National Provider Identifier
1528082096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 78-18 P
- Practice address
- 1706 E Joyce Blvd
Suite 3
Fayetteville, AR 72703-5238 - Phone
- (479) 442-9381
- Fax
- (479) 442-9396
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 78-18 P | AR | Primary |
Addresses
Primary practice location
1706 E Joyce Blvd
Suite 3
Fayetteville, AR 72703-5238
Mailing address
1706 E Joyce Blvd
Suite 3
Fayetteville, AR 72703-5238
Phone (479) 442-9381
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78-18 P | AR | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1528082096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1706 E JOYCE BLVD",
"address_2": "SUITE 3",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727035238",
"telephone_number": "479-442-9381",
"fax_number": "479-442-9396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1706 E JOYCE BLVD",
"address_2": "SUITE 3",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727035238",
"telephone_number": "479-442-9381",
"fax_number": "479-442-9396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACK",
"first_name": "RICHARD",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "AR",
"license": "78-18 P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.