Provider Demographics
NPI:1811103187
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:321-984-0032
Practice Address - Street 1:160 MALABAR RD SW
Practice Address - Street 2:SUITE 105
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2911
Practice Address - Country:US
Practice Address - Phone:321-674-0200
Practice Address - Fax:321-674-3922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL J BEFANIS MD PA DBA BREVARD EYE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-15
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086944908Medicaid
FL252338805Medicaid
FL252338805Medicaid
FL086944908Medicaid