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General NPI Number Information
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NPI Number | 1073064382
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Entity Type | Organization
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Legal Business Name | A.DESROSIERS III, M.D., CORP
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 6705 S RED RD SUITE 516
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3622
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Country | US
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Telephone | 305-403-2922
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Fax | 305-517-3130
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Provider Business Mailing Address
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Address Line | 6705 S RED RD SUITE 516
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3622
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Country | US
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Telephone | 305-403-2922
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Fax | 305-517-3130
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. ARTHUR DESROSIERS III
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Credential | M.D.
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Telephone | 305-403-2922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | ME110935
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3822
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9108751
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME110935
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License Number State | FL
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