Healthcare Provider Details

I. General information

NPI: 1811103187
Provider Name (Legal Business Name): PAUL J BEFANIS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MALABAR RD SW SUITE 105
PALM BAY FL
32907-2911
US

IV. Provider business mailing address

665 S APOLLO BLVD
MELBOURNE FL
32901-1485
US

V. Phone/Fax

Practice location:
  • Phone: 321-674-0200
  • Fax: 321-674-3922
Mailing address:
  • Phone: 321-984-3200
  • Fax: 321-984-0032

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: M.D.
Phone: 321-984-3200