Individual
GABRIEL L DERSAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4704 AMBASSADOR CAFFERY PKWY FL 1, LAFAYETTE, LA 70508-6908
(337) 470-5920
(885) 431-6868
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0474
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
103060
MN
207XP3100X
Pediatric Orthopaedic Surgery Physician
036136684
IL
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
MD.201862
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033553
—
LA
Enumeration date
07/25/2007
Last updated
12/19/2022
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