Provider Demographics
NPI:1790161172
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:CEO
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 ROAD
Mailing Address - Street 2:SUITE 516
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-403-2922
Mailing Address - Fax:305-517-3130
Practice Address - Street 1:6705 S RED ROAD
Practice Address - Street 2:SUITE 516
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143
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:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110935204E00000X, 208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty