Provider Demographics
NPI:1386671790
Name:ARMSTRONG, LARRY A (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 N FUTRALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-463-3000
Mailing Address - Fax:479-463-3050
Practice Address - Street 1:3336 N FUTRALL DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-463-3000
Practice Address - Fax:479-463-3050
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2983207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143654003Medicaid
ARP00327509OtherRR MCR
AR5L910OtherAR BCBS
AR5L910OtherAR BCBS
AR5L910Medicare ID - Type Unspecified
AR5L910F503Medicare PIN