Healthcare Provider Details

I. General information

NPI: 1881061083
Provider Name (Legal Business Name): PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 RODEL CV SUITE 2001
LAKE MARY FL
32746-5716
US

IV. Provider business mailing address

235 N WESTMONTE DR
ALTAMONTE SPRINGS FL
32714-3345
US

V. Phone/Fax

Practice location:
  • Phone: 407-302-3106
  • Fax: 321-203-4602
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
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