Provider Demographics
NPI:1962832964
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 - 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:407-262-5715
Mailing Address - Street 1:21 W COLUMBIA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1133
Mailing Address - Country:US
Mailing Address - Phone:407-381-7387
Mailing Address - Fax:407-381-7387
Practice Address - Street 1:21 W COLUMBIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1133
Practice Address - Country:US
Practice Address - Phone:407-381-7387
Practice Address - Fax:407-971-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66010207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062757700Medicaid
97037Medicare PIN