MEDICARE: DR. ROBERT J BACKER MD

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	174400000X	Specialist	MDR3D60	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	140005147	OTHER	MO	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	O06214	OTHER	MO	EXCLUSIVE CHOICE
2	43755	OTHER	MO	GROUP HEALTH PLAN
3	132437	OTHER	MO	HEALTHLINK
4	5810	OTHER	MO	BLUE CROSS BLUE SHIELD
5	0600013	OTHER	MO	UNITED HEALTHCARE
6	431725782	OTHER	MO	TAX ID #
8	261839808	OTHER		TAX ID

General Provider Information

NPI Number	:	1790788941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J BACKER MD

Provider Business Mailing Address
First Line	:	621 S NEW BALLAS RD
Second Line	:	STE 297A
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-251-6364
Fax Number	:	314-251-7897

Provider Business Practice Location Address
First Line	:	621 S NEW BALLAS RD
Second Line	:	STE 297A
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-251-6364
Fax Number	:	314-251-7897

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/10/2011

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Directions to “ DR. ROBERT J BACKER MD” Practice Location

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