Basic Information
| Provider Information | |||||||||
| NPI: | 1255331195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARMITAGE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 960 N 16TH ST | ||||||||
| Address2: | SUITE #304 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417448682 | ||||||||
| FaxNumber: | 5417448608 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 N 16TH ST | ||||||||
| Address2: | SUITE #304 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417448682 | ||||||||
| FaxNumber: | 5417448608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 04/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD154141 | OR | Y | Other Service Providers | Specialist |
No ID Information.