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General NPI Number Information
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NPI Number | 1285139410
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Entity Type | Individual
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Provider Name | RONALD DESROUILLERES DO
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 4105 MATTHEWS MINT HILL RD
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City | MATTHEWS
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State | NC
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Zip | 28105-3633
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Country | US
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Telephone | 704-316-3095
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Fax | 704-316-3096
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 315392
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024-01643
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License Number State | NC
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