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General NPI Number Information
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NPI Number | 1891001939
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Entity Type | Organization
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Legal Business Name | PA ASSOCIATES 'LLC.'
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 110 ORLANDO BLVD
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City | INDIALANTIC
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State | FL
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Zip | 32903-3419
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Country | US
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Telephone | 321-506-6781
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 847
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City | ROSELAND
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State | FL
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Zip | 32957-0847
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Country | US
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Telephone | 321-506-6781
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANTHONY A. MOORE
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Credential | PA-C
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Telephone | 321-506-6781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9104697
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License Number State | FL
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