MEDICARE: PHYSICIAN ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	208000000X	Pediatrics Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1215425780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	235 N WESTMONTE DR
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 E SR 434 FL 1
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-2746
Country	:	US
Telephone Number	:	407-389-5300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENNIS J. BUHRING
Credential	:
Telephone Number	:	407-649-7401

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	04/30/2018

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