Provider Demographics
NPI:1215119185
Name:FERNANDEZ, MAXIMO JOSE (MD)
Entity type:Individual
Prefix:
First Name:MAXIMO
Middle Name:JOSE
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4765 VOLUNTEER RD STE 404
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2128
Mailing Address - Country:US
Mailing Address - Phone:954-374-7545
Mailing Address - Fax:954-374-7543
Practice Address - Street 1:4765 VOLUNTEER RD STE 404
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-2128
Practice Address - Country:US
Practice Address - Phone:954-374-7545
Practice Address - Fax:954-374-7543
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2025-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 107066207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003521900Medicaid
FLFM440ZOtherMEDICARE PTAN