Healthcare Provider Details

I. General information

NPI: 1033188016
Provider Name (Legal Business Name): MAX A NEVAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 BARNES RD
COLORADO SPRINGS CO
80922
US

IV. Provider business mailing address

2 S CASCADE AVE STE 140
COLORADO SPRINGS CO
80903-1604
US

V. Phone/Fax

Practice location:
  • Phone: 719-522-1133
  • Fax: 719-570-0602
Mailing address:
  • Phone: 719-866-6568
  • Fax: 719-538-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0026917
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: