Provider Demographics
NPI:1295796720
Name:NARCISO, PHILIPP (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIPP
Middle Name:
Last Name:NARCISO
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 1:1617 N WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2046
Mailing Address - Country:US
Mailing Address - Phone:870-234-7676
Mailing Address - Fax:870-562-2560
Practice Address - Street 1:2613 BAMBI LN
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5286
Practice Address - Country:US
Practice Address - Phone:870-881-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4548207Q00000X
CAA98575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158539001Medicaid
AR5N363OtherBCBS
ARI43625Medicare UPIN
AR5N363C809Medicare PIN
AR5N363OtherBCBS