Healthcare Provider Details

I. General information

NPI: 1952702805
Provider Name (Legal Business Name): BRUCE ARMSTRONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 ALEXANDER ST SUITE E
TAOS NM
87571-6944
US

IV. Provider business mailing address

PO BOX 1888 114 ALEXANDER ST, SUITE E
TAOS NM
87571-1888
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-7827
  • Fax: 575-758-0715
Mailing address:
  • Phone: 505-758-7827
  • Fax: 575-758-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number88824
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: