Provider Demographics
NPI:1740258714
Name:SOUTHEAST FLORIDA PHYSICIAN ASSISTANT ASSOC. INC
Entity type:Organization
Organization Name:SOUTHEAST FLORIDA PHYSICIAN ASSISTANT ASSOC. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:561-676-8169
Mailing Address - Street 1:6136 KINGS GATE CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-2456
Mailing Address - Country:US
Mailing Address - Phone:561-676-8169
Mailing Address - Fax:845-357-1144
Practice Address - Street 1:6136 KINGS GATE CIR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-2456
Practice Address - Country:US
Practice Address - Phone:561-676-8169
Practice Address - Fax:845-357-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3075363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty