Provider Demographics
NPI:1760613137
Name:DUPART, MARCUS JOSEPH SR
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:JOSEPH
Last Name:DUPART
Suffix:SR
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 1:11025 ACOMA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-2840
Mailing Address - Country:US
Mailing Address - Phone:504-905-4773
Mailing Address - Fax:
Practice Address - Street 1:11025 ACOMA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-2840
Practice Address - Country:US
Practice Address - Phone:504-905-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist