Provider Demographics
NPI:1245314574
Name:SPRAY, JR, ROBERT L (PHD PA)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:SPRAY, JR
Suffix:
Gender:M
Credentials:PHD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR75-18P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56447OtherBLUE CROSS BLUE SHIELD
AR105861719Medicaid
AR56447Medicare ID - Type UnspecifiedPROVIDER NUMBER