Provider Demographics
NPI:1194890467
Name:ARMSTRONG, CHARLES R (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 INDEPENDENCE SQ
Mailing Address - Street 2:P.O. BOX 1100
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4235
Mailing Address - Country:US
Mailing Address - Phone:417-257-7451
Mailing Address - Fax:417-256-9277
Practice Address - Street 1:3102 INDEPENDENCE SQUARE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4235
Practice Address - Country:US
Practice Address - Phone:417-257-7451
Practice Address - Fax:417-256-9277
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6B282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201702727Medicaid
MOP00007110OtherRAILROAD MEDICARE
AR112505001Medicaid
MOA13679Medicare UPIN
MO201702727Medicaid