Healthcare Provider Details

I. General information

NPI: 1720245756
Provider Name (Legal Business Name): PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7416 RED BUG LAKE RD
OVIEDO FL
32765-7154
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: 407-381-7387
  • Fax: 407-977-4128
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS J. BUHRING
Title or Position: CEO/MEMBER OF THE BOARD
Credential:
Phone: 407-262-5710