Provider Demographics
NPI:1467063792
Name:DIPASUPIL, MARC EDMOND GARCIA
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:EDMOND GARCIA
Last Name:DIPASUPIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FAIR PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1720
Mailing Address - Country:US
Mailing Address - Phone:501-500-3500
Mailing Address - Fax:501-904-3620
Practice Address - Street 1:800 FAIR PARK BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1720
Practice Address - Country:US
Practice Address - Phone:501-500-3500
Practice Address - Fax:501-904-3620
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant