MEDICARE: ROBERT L SPRAY JR PHD PA

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
1	103TC0700X	Clinical Psychologist	75-18P	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56447	OTHER	AR	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932281193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L SPRAY JR PHD PA

Provider Business Mailing Address
First Line	:	PO BOX 10105
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-0105
Country	:	US
Telephone Number	:	479-452-1658
Fax Number	:	479-452-3865

Provider Business Practice Location Address
First Line	:	3104 S 70TH ST
Second Line	:	SUITE #103
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5018
Country	:	US
Telephone Number	:	479-452-1658
Fax Number	:	479-452-3865

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT L. SPRAY JR.
Credential	:	PH.D.
Telephone Number	:	479-452-1658

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	03/14/2011

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