Provider Demographics
NPI:1932281193
Name:ROBERT L SPRAY JR PHD PA
Entity Type:Organization
Organization Name:ROBERT L SPRAY JR PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:479-452-1658
Mailing Address - Street 1:PO BOX 10105
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0105
Mailing Address - Country:US
Mailing Address - Phone:479-452-1658
Mailing Address - Fax:479-452-3865
Practice Address - Street 1:3104 S 70TH ST
Practice Address - Street 2:SUITE #103
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5018
Practice Address - Country:US
Practice Address - Phone:479-452-1658
Practice Address - Fax:479-452-3865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR75-18P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56447OtherBLUE CROSS BLUE SHIELD
AR105861719Medicaid
AR56447Medicare ID - Type UnspecifiedPROVIDER NUMBER