MEDICARE: PHYSICIAN ASSOCIATES LLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1801242961
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	:	63 RILEY RD
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5419
Country	:	US
Telephone Number	:	407-930-6900
Fax Number	:	321-203-4669

Authorized Official
Title or Position	:	CEO/CHAIRMAN OF THE BOARD
Name	:	DENNIS J. BUHRING
Credential	:
Telephone Number	:	407-649-7401

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	10/04/2017

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