GABRIEL LEESE DERSAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036136684

License Status

NOT RENEWED

Business

Title

First Name

GABRIEL

Middle

LEESE

Last Name

DERSAM

Business Name

GABRIEL LEESE DERSAM MD

Original Issue Date

10/16/2014

Effective Date

10/16/2014

Expiration Date

07/31/2017

City

BROUSSARD

State

Zip

70518

County

LOUISIANA

Ever Disciplined

LastModifiedDate

11/01/2017