Provider Demographics
NPI:1952702805
Name:ARMSTRONG, BRUCE
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:
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 1888
Mailing Address - Street 2:114 ALEXANDER ST, SUITE E
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1888
Mailing Address - Country:US
Mailing Address - Phone:505-758-7827
Mailing Address - Fax:575-758-0715
Practice Address - Street 1:114 ALEXANDER ST
Practice Address - Street 2:SUITE E
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6944
Practice Address - Country:US
Practice Address - Phone:505-758-7827
Practice Address - Fax:575-758-0715
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM88824171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications