Healthcare Provider Details

I. General information

NPI: 1821255969
Provider Name (Legal Business Name): PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 KELTON AVE SUITE A & B
OCOEE FL
34761-3175
US

IV. Provider business mailing address

235 N WESTMONTE DR PHYSICIAN ASSOCIATES LLC
ALTAMONTE SPRINGS FL
32714-3345
US

V. Phone/Fax

Practice location:
  • Phone: 407-381-7369
  • Fax: 407-306-6375
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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS J. BUHRING
Title or Position: CEO
Credential:
Phone: 407-262-5710