Healthcare Provider Details

I. General information

NPI: 1740504455
Provider Name (Legal Business Name): PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 DAIRY RD
MELBOURNE FL
32904-5209
US

IV. Provider business mailing address

235 N WESTMONTE DR
ALTAMONTE SPRINGS FL
32714-3345
US

V. Phone/Fax

Practice location:
  • Phone: 321-259-1054
  • Fax: 321-989-0246
Mailing address:
  • Phone: 407-262-5710
  • Fax: 407-262-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME77004
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME77004
License Number StateFL

VIII. Authorized Official

Name: DENNIS J BUHRING
Title or Position: CEO
Credential:
Phone: 407-262-5757