Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | ME25684 | FL |
NPI | 1073566840 |
---|---|
Provider Name | Dr. Paul Michael Desrosiers |
First Address | Orlando, FL 32806-1114 |
Second Address | Orlando, FL 32806-1114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
069451700 | (05) | FL |
47666 | BCBS OF FL (01) | FL |
ME25684 | MEDICAL LICENSE (01) | FL |