Provider Demographics
NPI:1235207523
Name:ARMITAGE, DAVID R (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:ARMITAGE
Suffix:
Gender:M
Credentials:PA-C
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 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2419
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1501 E CALVADA BLVD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5807
Practice Address - Country:US
Practice Address - Phone:775-727-5509
Practice Address - Fax:775-727-5696
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV620363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1235207523Medicaid
NV1235207523Medicaid
NVCY890XMedicare PIN