Provider Demographics
NPI:1073064382
Name:A.DESROSIERS III, M.D., CORP
Entity Type:Organization
Organization Name:A.DESROSIERS III, M.D., CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:DESROSIERS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:305-403-2922
Mailing Address - Street 1:6705 S RED RD
Mailing Address - Street 2:SUITE 516
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3622
Mailing Address - Country:US
Mailing Address - Phone:305-403-2922
Mailing Address - Fax:305-517-3130
Practice Address - Street 1:6705 S RED RD
Practice Address - Street 2:SUITE 516
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3622
Practice Address - Country:US
Practice Address - Phone:305-403-2922
Practice Address - Fax:305-517-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110935208200000X, 2082S0105X
FLPO3822213ES0103X
FLPA9108751363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14L2XOtherBLUE CROSS BLUE SHIELD
FL0005967100Medicaid
FL015464600Medicaid