Provider Demographics
NPI:1871659342
Name:ARMSTEAD BAEZ, PHYLLIS (MD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:ARMSTEAD BAEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 TAYSIDE ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-8724
Mailing Address - Country:US
Mailing Address - Phone:910-850-9927
Mailing Address - Fax:
Practice Address - Street 1:417 VANCE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-4001
Practice Address - Country:US
Practice Address - Phone:910-567-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0099007552084P0800X
SCSCL353652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130RRMedicaid
SC327877Medicaid
SC327877Medicaid
NC89130RRMedicaid