Healthcare Provider Details

I. General information

NPI: 1568642072
Provider Name (Legal Business Name): GREGORY W ARMSTRONG CPO/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDREN'S WAY, SLOT 104
LITTLE ROCK AR
72202
US

IV. Provider business mailing address

1 CHILDREN'S WAY, SLOT 104
LITTLE ROCK AR
72202
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-2262
  • Fax: 501-364-3564
Mailing address:
  • Phone: 501-364-2262
  • Fax: 501-364-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberOPP00268
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberOPP00268
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOPP00268
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: