MEDICARE: SOUTHEAST FLORIDA PHYSICIAN ASSISTANT ASSOC. INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA3075	FL

General Provider Information

NPI Number	:	1740258714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST FLORIDA PHYSICIAN ASSISTANT ASSOC. INC

Provider Business Mailing Address
First Line	:	6136 KINGS GATE CIR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-2456
Country	:	US
Telephone Number	:	561-676-8169
Fax Number	:	845-357-1144

Provider Business Practice Location Address
First Line	:	6136 KINGS GATE CIR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-2456
Country	:	US
Telephone Number	:	561-676-8169
Fax Number	:	845-357-1144

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STUART REICH
Credential	:	PA
Telephone Number	:	561-676-8169

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	12/05/2008

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