Healthcare Provider Details

I. General information

NPI: 1881654218
Provider Name (Legal Business Name): PAUL LEE ARMSTRONG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13170 CENTRAL AVE SE STE B345
ALBUQUERQUE NM
87123
US

IV. Provider business mailing address

PO BOX 8387
ALBUQUERQUE NM
87198-8387
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-6319
  • Fax:
Mailing address:
  • Phone: 505-841-1000
  • Fax: 505-843-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number104416
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-870
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number98-PA09
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2024007425
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601013180
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: