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General NPI Number Information
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NPI Number | 1730677204
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Entity Type | Organization
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Legal Business Name | PHYSICIAN ASSOCIATES LLC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 4932 SR 46 STE 1090
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City | SANFORD
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State | FL
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Zip | 32771-9244
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Country | US
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Telephone | 407-389-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 235 N WESTMONTE DR
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | DENNIS J. BUHRING
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Credential |
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Telephone | 407-649-7401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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