Provider Demographics
NPI:1629071576
Name:DESIR, RANLEY M (MD)
Entity Type:Individual
Prefix:DR
First Name:RANLEY
Middle Name:M
Last Name:DESIR
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 1:2845 AVENTURA BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3118
Mailing Address - Country:US
Mailing Address - Phone:305-749-0150
Mailing Address - Fax:305-749-0151
Practice Address - Street 1:2845 AVENTURA BLVD
Practice Address - Street 2:STE 100
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3118
Practice Address - Country:US
Practice Address - Phone:305-749-0150
Practice Address - Fax:305-749-0151
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372379800Medicaid
FLE61686Medicare UPIN
FL10669ZMedicare ID - Type Unspecified