GABRIEL L DERSAM (NPI# 1487844650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487844650 |
| Entity Type | Individual |
| Full Name | GABRIEL L DERSAM |
| Credential | MD |
| Practice Address |
4704 Ambassador Caffery Pkwy Lafayette LA 70508-6908 |
| Mailing Address |
5959 S Sherwood Forest Blvd Baton Rouge LA 70816-6038 |
| Practice Telephone | 3373713102 |
| Practice Fax Number | 3373713151 |
| Mailing Telephone | 2255260002 |
| Mailing Fax Number | 2257659196 |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2020-02-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 103060 | MN | Allopathic & Osteopathic Physicians |
| Y | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
MD.201862 | LA | Allopathic & Osteopathic Physicians |
| N | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
036136684 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1033553 | 05 |
| Street Address |
4704 AMBASSADOR CAFFERY PKWY |
| City | LAFAYETTE |
| State | LA |
| Zip Code | 70508-6908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427080738 | Kenneth W Falterman | Surgery | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508-6908 | 2006-07-07 |
| 1124673439 | David Paul Bailey | Physician Assistant | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508-6908 | 2019-08-04 |
| 1144673344 | Janci Bienvenu Detwiler | Nurse Practitioner | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508-6908 | 2016-07-22 |
| 1780009613 | Sarah Iblings | Nurse Practitioner | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508-6908 | 2014-03-01 |
| 1669715322 | Ryan Patrick Farmer | Orthopaedic Surgery | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508 | 2013-04-01 |
| 1568788479 | Kenneth Richmond Habetz | Psychiatry & Neurology | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508-6908 | 2010-04-16 |
| 1306071162 | Amy Arceneaux Vitte | Pediatrics | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508-6908 | 2009-05-22 |
| 1144397472 | Deiadra Garrett | Pediatrics | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508-6908 | 2006-11-30 |
| 1447325360 | Janna Kirsten Flint Wilson | Pediatrics | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508-6908 | 2006-11-24 |
| 1407878929 | Leslie Gauthier Fontenot | Dietitian, Registered | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508-6908 | 2006-07-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868676 | Cypress Bend Oral & Maxillofacial Surgery | Dentist | 106 Rue Bastille, Lafayette, LA 70508 | 2020-07-13 |
| 1184250607 | Learning Grove Therapy LLC | Clinic/Center | 105 Anaheim Lane, Lafayette, LA 70508 | 2020-03-16 |
| 1780218727 | Jennifer Trumps | Case Manager/Care Coordinator | 200 Entergy Parkway, Lafayette, LA 70508 | 2020-02-28 |
| 1740749605 | Hunter Sy Arceneaux | Physical Therapist | 1700 Kaliste Saloom Road, Building 3, Suite 300, Lafayette, LA 70508 | 2019-03-19 |
| 1295292787 | Brad Michael Gros | Counselor | 160 South Beadle Road, Lafayette, LA 70508 | 2019-02-21 |
| 1205337581 | Alternative Perspectives, LLC | Clinic/Center | 2807 Kaliste Saloom Rd Ste B, Lafayette, LA 70508 | 2018-02-22 |
| 1124528807 | Zachariah James Hebert | Counselor | 1602 W Pinhook Rd Suite 100a, The Family Tree, Lafayette, LA 70508 | 2018-02-19 |
| 1164934477 | Ilyas Munshi, Md Apmc | Non-Pharmacy Dispensing Site | 99 W. Martial Ave, Lafayette, LA 70508 | 2017-10-26 |
| 1447761226 | Louisiana Orthopaedic Specialists, LLC | Durable Medical Equipment & Medical Supplies | 4231 Ambassador Caffery Pkwy, Suite 102, Lafayette, LA 70508 | 2017-10-19 |
| 1306365457 | Mk Dixon Counseling and Consulting | Counselor | 105 Industrial Parkway, Lafayette, LA 70508 | 2017-09-10 |
| Find all providers in zip 70508 | ||||
| Taxonomy Code | 207XP3100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Pediatric Orthopaedic Surgery |
| An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents. These may include limb and spine deformities (such as club foot, scoliosis); gait abnormalities (limping); bone and joint infections; broken bones. |
| Notes: Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669715322 | Ryan Patrick Farmer | Orthopaedic Surgery | 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508 | 2013-04-01 |
| 1124205372 | Women's & Children's Pediatric Orthopedic Center, LLC | Orthopaedic Surgery | 4630 Ambassador Caffery Pkwy, Suite 408, Lafayette, LA 70508-6949 | 2008-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083831887 | Clark A Gunderson | Orthopaedic Surgery | 2615 Enterprise Blvd, Lake Charles, LA 70601 | 2007-04-20 |
| 1164438099 | John A. Fox | Orthopaedic Surgery | 7925 Youree Dr Ste 200, Shreveport, LA 71105-5134 | 2006-07-31 |
| 1568803732 | Shriners Hospitals for Children | Orthopaedic Surgery | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2013-07-16 |
| 1306193917 | Sushant D Ghate | Orthopaedic Surgery | 200 Henry Clay Ave, New Orleans, LA 70118-5720 | 2012-08-14 |
| 1760706782 | Mccall G Mcdaniel | Orthopaedic Surgery | 71211 Highway 21, Covington, LA 70433-7121 | 2010-03-19 |
| 1740448299 | Janay Mckie | Orthopaedic Surgery | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2008-05-30 |
| 1063684314 | John Robert Faust | Orthopaedic Surgery | 7777 Hennessy Blvd Ste 306, Baton Rouge, LA 70808-4365 | 2008-03-27 |
| 1750588836 | Michael Heffernan | Orthopaedic Surgery | 200 Henry Clay Ave, New Orleans, LA 70118-5720 | 2007-07-02 |
| 1770701898 | David Hawkes Steiner | Orthopaedic Surgery | 506 S 6th St, Leesville, LA 71446-4442 | 2007-04-23 |
| 1538259478 | James Bennett | Orthopaedic Surgery | 1430 Tulane Ave, New Orleans, LA 70112-2632 | 2006-10-13 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on GABRIEL L DERSAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.