Healthcare Provider Details

I. General information

NPI: 1144487273
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

4401 S ORANGE AVE SUITE 108
ORLANDO FL
32806-6946
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: 407-245-1420
  • Fax: 407-245-1465
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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS J BURHING
Title or Position: CEO, CHAIRMAN OF THE BOARD
Credential:
Phone: 407-262-5710