Provider Demographics
NPI:1568545663
Name:ARMSTRONG, BRADLEY RAY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:RAY
Last Name:ARMSTRONG
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 1:4005 TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6377
Mailing Address - Country:US
Mailing Address - Phone:214-618-0908
Mailing Address - Fax:
Practice Address - Street 1:3535 S INTERSTATE 35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6850
Practice Address - Country:US
Practice Address - Phone:940-384-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287648401Medicaid
TX287648402Medicaid
TXP00323508OtherRAILROAD
TX287648403Medicaid
TXTXB125209Medicare PIN
TXTXB125205Medicare PIN
TXTXB125207Medicare PIN