Basic Information
| Provider Information | |||||||||
| NPI: | 1740258714 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST FLORIDA PHYSICIAN ASSISTANT ASSOC. INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6136 KINGS GATE CIR | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334842456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616768169 | ||||||||
| FaxNumber: | 8453571144 | ||||||||
| Practice Location | |||||||||
| Address1: | 6136 KINGS GATE CIR | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334842456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616768169 | ||||||||
| FaxNumber: | 8453571144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 12/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | REICH | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5616768169 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA3075 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.