Individual
DR. BETHANY DESROCHES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, MS
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
BP10050157
TX
208800000X
Urology Physician
Primary
25MA10578000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA10578000
NJ MEDICAL LICENSE
NJ
01
—
BP10050157
TEXAS MEDICAL BOARD
TX
Enumeration date
05/12/2014
Last updated
07/02/2019
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