Provider Demographics
NPI:1609033729
Name:PHYSICIAN ASSOCIATES LLC
Entity Type:Organization
Organization Name:PHYSICIAN ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEMBER OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUHRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-262-5710
Mailing Address - Street 1:PO BOX 522468
Mailing Address - Street 2:PHYSICIAN ASSOCIATES LLC
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32752-2468
Mailing Address - Country:US
Mailing Address - Phone:407-262-5710
Mailing Address - Fax:407-262-5796
Practice Address - Street 1:6447 S. CHICKASAW TRAIL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829
Practice Address - Country:US
Practice Address - Phone:407-277-9242
Practice Address - Fax:407-277-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062757711Medicaid
FL062757700Medicaid
FL062757700Medicaid
FLCB3518Medicare PIN