Healthcare Provider Details

I. General information

NPI: 1073064382
Provider Name (Legal Business Name): A.DESROSIERS III, M.D., CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 S RED RD SUITE 516
SOUTH MIAMI FL
33143-3622
US

IV. Provider business mailing address

6705 S RED RD SUITE 516
SOUTH MIAMI FL
33143-3622
US

V. Phone/Fax

Practice location:
  • Phone: 305-403-2922
  • Fax: 305-517-3130
Mailing address:
  • Phone: 305-403-2922
  • Fax: 305-517-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME110935
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME110935
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3822
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9108751
License Number StateFL

VIII. Authorized Official

Name: DR. ARTHUR DESROSIERS III
Title or Position: C.E.O.
Credential: M.D.
Phone: 305-403-2922