Healthcare Provider Details

I. General information

NPI: 1134598675
Provider Name (Legal Business Name): PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 MAGUIRE RD
OCOEE FL
34761-4744
US

IV. Provider business mailing address

235 N WESTMONTE DR # MP146
ALTAMONTE SPRINGS FL
32714-3345
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-6506
  • Fax: 407-654-6556
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateFL

VIII. Authorized Official

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