Dersam, Gabriel L

Dersam, Gabriel L is an individual health care provider with primary practice located at 4704 Ambassador Caffery Pkwy Fl 1 , Lafayette LA 70508-6908. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Pediatric Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Pediatric Orthopaedic Surgery is his primary health care specialty. Dersam, Gabriel L can be contacted via phone (337) 470-5920.

Contact Information

Primary practice address
4704 Ambassador Caffery Pkwy Fl 1 Lafayette LA 70508-6908
Phone: (337) 470-5920
Fax: (885) 431-6868
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 103060 Minnesota
Allopathic & Osteopathic Physicians / Pediatric Orthopaedic Surgery 207XP3100X 036136684 Illinois
Allopathic & Osteopathic Physicians / Pediatric Orthopaedic Surgery 207XP3100X MD.201862 Louisiana

Profile Details

NPI number 1487844650
LBN Legal business name Dersam, Gabriel L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 25th, 2007
Last updated Dec 19th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487844650 NPPES
Louisiana MEDICAID 1033553

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