Provider Demographics
NPI:1881025351
Name:PHYSICIAN ASSOCIATES LLC
Entity Type:Organization
Organization Name:PHYSICIAN ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
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:407-649-7401
Mailing Address - Street 1:77 W UNDERWOOD ST FL 5
Mailing Address - Street 2:MP146
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1122
Mailing Address - Country:US
Mailing Address - Phone:407-649-7400
Mailing Address - Fax:407-649-7429
Practice Address - Street 1:3724 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5483
Practice Address - Country:US
Practice Address - Phone:407-306-6306
Practice Address - Fax:407-306-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63815207QA0505X
FLME113197207V00000X
FLME66473208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
97037Medicare PIN