Provider Demographics
NPI:1033188016
Name:NEVAREZ, MAX A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:A
Last Name:NEVAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2 S CASCADE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:719-866-6568
Mailing Address - Fax:719-538-2999
Practice Address - Street 1:6340 BARNES RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922
Practice Address - Country:US
Practice Address - Phone:719-522-1133
Practice Address - Fax:719-570-0602
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0026917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01269174Medicaid
X7368Medicare ID - Type Unspecified
CO01269174Medicaid