Provider Demographics
NPI:1073566840
Name:DESROSIERS, PAUL MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:DESROSIERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W GORE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1114
Mailing Address - Country:US
Mailing Address - Phone:321-841-3303
Mailing Address - Fax:321-841-3305
Practice Address - Street 1:60 W GORE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1114
Practice Address - Country:US
Practice Address - Phone:321-841-3303
Practice Address - Fax:321-841-3305
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME256842080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME25684OtherMEDICAL LICENSE
FL47666OtherBCBS OF FL
FL069451700Medicaid
FL47666XMedicare PIN
FL069451700Medicaid
FL47666UMedicare PIN
FL23155XMedicare PIN
FL47666XMedicare PIN