Provider Demographics
NPI:1215905831
Name:BACKMAN, JOHN RANDOLPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RANDOLPH
Last Name:BACKMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SANTA FE DR
Mailing Address - Street 2:STE 204
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5179
Mailing Address - Country:US
Mailing Address - Phone:760-944-7300
Mailing Address - Fax:760-633-3949
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-944-7300
Practice Address - Fax:760-633-3949
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29156174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G291560OtherMEDI-CAL NUMBER
CAA43966Medicare UPIN
CAWG29156FMedicare ID - Type UnspecifiedPPIN#