Provider Demographics
NPI:1285669002
Name:ARMISTEAD, DRURY L (MD)
Entity Type:Individual
Prefix:DR
First Name:DRURY
Middle Name:L
Last Name:ARMISTEAD
Suffix:
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 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6740
Mailing Address - Fax:252-752-6600
Practice Address - Street 1:1850 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5704
Practice Address - Country:US
Practice Address - Phone:252-413-6740
Practice Address - Fax:252-752-6600
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21585207N00000X, 207R00000X
NC2012-00923207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920892Medicaid
NCNC8257AOtherMEDICARE
NCNC8257BOtherMEDICARE
NCNC8257AOtherMEDICARE