Healthcare Provider Details

I. General information

NPI: 1568914091
Provider Name (Legal Business Name): PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7243 DELLA DRIVE
ORLANDO FL
32819-9999
US

IV. Provider business mailing address

235 N WESTMONTE DR
ALTAMONTE SPRINGS FL
32714-3345
US

V. Phone/Fax

Practice location:
  • Phone: 407-481-7366
  • Fax: 321-203-4647
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
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State
# 6
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