Provider Demographics
NPI:1609828433
Name:ARMSTRONG, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ARMSTRONG
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:PO BOX 1000 DEPT 590
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-382-1200
Mailing Address - Fax:901-382-8070
Practice Address - Street 1:1722 E REELFOOT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6050
Practice Address - Country:US
Practice Address - Phone:731-885-6300
Practice Address - Fax:731-885-6386
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027706174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4032315OtherBLUE SHIELD TN PROVIDER #
TN3827048Medicare ID - Type UnspecifiedTN MEDICARE INDIVIDUAL #
G82879Medicare UPIN