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GABRIEL L DERSAM MD NPI 1487844650


NPI Information

NPI: 1487844650
Provider Name: GABRIEL L DERSAM, MD
Classification: Orthopaedic Surgery - 207XP3100X
Entity Type: Individual

Specialization: Pediatric Orthopaedic Surgery

Organization: LOURDES PHYSICIAN GROUP LLC

PECOS Registration: Yes

Address:
4704 AMBASSADOR CAFFERY PKWY FL 1
LAFAYETTE, LA
ZIP 70508
Phone: (337) 470-5920
Get Directions

Gabriel L Dersam, MD is a pediatric orthopaedic surgery orthopaedic surgery in Lafayette, LA with 24 years of experience. The provider is 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. Gabriel L Dersam, MD NPI is 1487844650. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE
Graduation Year:2000

The provider's business location address is:

4704 AMBASSADOR CAFFERY PKWY FL 1
LAFAYETTE, LA
ZIP 70508-908
Phone: (337) 470-5920
Fax: (885) 431-6868

The NPI 1487844650 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/25/2007 and was last updated on 3/9/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207XP3100XOrthopaedic SurgeryPediatric Orthopaedic Surgery036136684ILLINOISNo
2207XP3100XOrthopaedic SurgeryPediatric Orthopaedic SurgeryMD.201862LOUISIANAYes
3207X00000XOrthopaedic Surgery103060MINNESOTANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11033553MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.