Provider Demographics
NPI:1871595686
Name:BACKES, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:BACKES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-255-5714
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2024-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN30055207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2529866OtherMEDICA HEALTH PLANS
060067019OtherRR MEDICARE
54G89BAOtherBLUE CROSS BLUE SHIELD
20820OtherARAZ GROUP AMERICAS PPO
1029878OtherPREFERRED ONE
1065675OtherFIRST HEALTH PLAN
121558OtherU CARE
MN383363100Medicaid
383363100OtherMEDICAL ASSISTANCE
HP34882OtherHEALTH PARTNERS
1065675OtherFIRST HEALTH PLAN
E75978Medicare UPIN