Healthcare Provider Details

I. General information

NPI: 1215119185
Provider Name (Legal Business Name): MAXIMO JOSE FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4765 VOLUNTEER RD STE 404
DAVIE FL
33330-2128
US

IV. Provider business mailing address

4765 VOLUNTEER RD STE 404
DAVIE FL
33330-2128
US

V. Phone/Fax

Practice location:
  • Phone: 954-374-7545
  • Fax: 954-374-7543
Mailing address:
  • Phone: 954-374-7545
  • Fax: 954-374-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME 107066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: