Provider Demographics
NPI:1487003422
Name:DESROCHES, MORAMED (MD, PMNP-BC)
Entity type:Individual
Prefix:
First Name:MORAMED
Middle Name:
Last Name:DESROCHES
Suffix:
Gender:M
Credentials:MD, PMNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE 110 #1006
Mailing Address - City:BOCA
Mailing Address - State:FL
Mailing Address - Zip Code:33432-2043
Mailing Address - Country:US
Mailing Address - Phone:561-786-5874
Mailing Address - Fax:561-973-1964
Practice Address - Street 1:980 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 110 #1006
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-786-5874
Practice Address - Fax:561-973-1964
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPA183363A00000X, 363A00000X
AZ8885363A00000X
FLHSE35829208D00000X
PR373-PA363A00000X
FLAPRN11026530363LP0808X, 363LP0808X
PR373-P.A.363A00000X
PR373208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty