Basic Information
| Provider Information | |||||||||
| NPI: | 1801242961 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 N WESTMONTE DR | ||||||||
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| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327143345 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 63 RILEY RD | ||||||||
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| City: | CELEBRATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347475419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079306900 | ||||||||
| FaxNumber: | 3212034669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2016 | ||||||||
| LastUpdateDate: | 10/04/2017 | ||||||||
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| AuthorizedOfficialLastName: | BUHRING | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/CHAIRMAN OF THE BOARD | ||||||||
| AuthorizedOfficialTelephone: | 4076497401 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.