Robert J Backer, MD
Individual provider Active NPI Specialist · Saint Louis, MO
NPI 1790788941 · NPPES record last updated Feb 10, 2011
Key facts
- NPI
- 1790788941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- MDR3D60 (MO)
- Practice address
- 621 S New Ballas Rd
Ste 297a
Saint Louis, MO 63141-8232 - Phone
- (314) 251-6364
- Fax
- (314) 251-7897
- NPI assigned
- May 23, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MDR3D60 | MO | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neurosurgical Specialists of West County Inc | Specialist | Past | Accepting new patients |
| Ozarks Medical Center | Past | Accepting new patients | |
| West County Neurological Surgery Inc | Specialist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MDR3D60 | MO | Yes |
Addresses
Primary practice location
621 S New Ballas Rd
Ste 297a
Saint Louis, MO 63141-8232
Mailing address
621 S New Ballas Rd
Ste 297a
Saint Louis, MO 63141-8232
Phone (314) 251-6364
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| O06214 | Other | MO | EXCLUSIVE CHOICE |
| 43755 | Other | MO | GROUP HEALTH PLAN |
| 132437 | Other | MO | HEALTHLINK |
| 5810 | Other | MO | BLUE CROSS BLUE SHIELD |
| 0600013 | Other | MO | UNITED HEALTHCARE |
| 431725782 | Other | MO | TAX ID # |
| 140005147 | Other | MO | MEDICARE RAILROAD |
| 261839808 | Other | TAX ID |
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.