Healthcare Provider Details

I. General information

NPI: 1750595344
Provider Name (Legal Business Name): PAUL J BEFANIS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 PORT MALABAR BLVD NE SUITE 2
PALM BAY FL
32905-5100
US

IV. Provider business mailing address

665 S APOLLO BLVD
MELBOURNE FL
32901-1485
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-1700
  • Fax: 321-952-3878
Mailing address:
  • Phone: 321-984-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL J BEFANIS
Title or Position: OWNER
Credential: MD
Phone: 321-984-3200