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General NPI Number Information
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NPI Number | 1740504455
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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 | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 2107 DAIRY RD
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City | MELBOURNE
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State | FL
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Zip | 32904-5209
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Country | US
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Telephone | 321-259-1054
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Fax | 321-989-0246
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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 | 407-262-5710
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Fax | 407-262-5796
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Authorized Official
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Title or Position | CEO
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Name | DENNIS J BUHRING
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Credential |
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Telephone | 407-262-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | ME77004
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME77004
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License Number State | FL
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