Provider Demographics
NPI:1033102181
Name:ARMSTRONG, SIMMIE JR (MD)
Entity Type:Individual
Prefix:
First Name:SIMMIE
Middle Name:
Last Name:ARMSTRONG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7010
Mailing Address - Country:US
Mailing Address - Phone:870-535-6461
Mailing Address - Fax:870-535-0594
Practice Address - Street 1:1400 W 43RD AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7010
Practice Address - Country:US
Practice Address - Phone:870-535-6461
Practice Address - Fax:870-535-0594
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2015-01-21
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
ARC6070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103070001Medicaid
ARD04299Medicare UPIN
AR50114Medicare ID - Type Unspecified