Provider Demographics
NPI:1336207786
Name:SUPINSKI, DAVID PAUL JR (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:SUPINSKI
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:88 MDOS- ER / SGOE
Mailing Address - Street 2:
Mailing Address - City:WRIGHT PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433
Mailing Address - Country:US
Mailing Address - Phone:937-257-0770
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR.
Practice Address - Street 2:ER/SGOE
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-0000
Practice Address - Country:US
Practice Address - Phone:937-257-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical