Provider Demographics
NPI:1487003422
Name:DESROCHES, MORAMED GERY SANDER (PA-C, MD)
Entity Type:Individual
Prefix:DR
First Name:MORAMED
Middle Name:GERY SANDER
Last Name:DESROCHES
Suffix:
Gender:M
Credentials:PA-C, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 NW 62ND DR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2043
Mailing Address - Country:US
Mailing Address - Phone:786-290-6544
Mailing Address - Fax:786-221-2623
Practice Address - Street 1:4800 N STATE ROAD 7 STE 103F
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5805
Practice Address - Country:US
Practice Address - Phone:786-290-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE35829207Q00000X, 208D00000X
PR373-PA363A00000X
FLTPPA183363A00000X, 363A00000X
AZ8885363A00000X
FLAPRN11026530363LP0808X
PR373-P.A.363A00000X
PR373208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty