Provider Demographics
NPI:1750595344
Name:PAUL J BEFANIS MD PA
Entity type:Organization
Organization Name:PAUL J BEFANIS MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEFANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-984-3200
Mailing Address - Street 1:665 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1485
Mailing Address - Country:US
Mailing Address - Phone:321-984-3200
Mailing Address - Fax:
Practice Address - Street 1:1091 PORT MALABAR BLVD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5100
Practice Address - Country:US
Practice Address - Phone:321-676-1700
Practice Address - Fax:321-952-3878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL J BEFANIS MD PA DBA BREVARD EYE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-10
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252338801Medicaid
FL086944904Medicaid
FL0539980001Medicare NSC
FL24403Medicare PIN