Healthcare Provider Details

I. General information

NPI: 1437673753
Provider Name (Legal Business Name): PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3078 DYER BLVD
KISSIMMEE FL
34741-7839
US

IV. Provider business mailing address

235 N WESTMONTE DR
ALTAMONTE SPRINGS FL
32714-3345
US

V. Phone/Fax

Practice location:
  • Phone: 407-389-5300
  • Fax: 407-389-5363
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DENNIS J. BUHRING
Title or Position: CEO/CHAIRMAN OF THE BOARD
Credential:
Phone: 407-649-7401