MEDICARE: MR. MARCUS JOSEPH DUPART SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist

General Provider Information

NPI Number	:	1760613137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCUS JOSEPH DUPART SR.

Provider Business Mailing Address
First Line	:	11025 ACOMA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-2840
Country	:	US
Telephone Number	:	504-905-4773
Fax Number	:

Provider Business Practice Location Address
First Line	:	11025 ACOMA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-2840
Country	:	US
Telephone Number	:	504-905-4773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	08/04/2009

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