Provider Demographics
NPI:1639249824
Name:DE SOLER, MARC (MD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:DE SOLER
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:PO BOX 1401
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-1401
Mailing Address - Country:US
Mailing Address - Phone:318-966-4917
Mailing Address - Fax:318-966-4916
Practice Address - Street 1:309 JACKSON ST 4TH FLOOR NICU
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-327-4917
Practice Address - Fax:318-327-4916
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08063R2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142665001Medicaid
LA1382141Medicaid
LA1382141Medicaid