Healthcare Provider Details

I. General information

NPI: 1184605370
Provider Name (Legal Business Name): MAX B MEDARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 STONEROCK CIR
ORLANDO FL
32819-8000
US

IV. Provider business mailing address

PO BOX 692409
ORLANDO FL
32869-2409
US

V. Phone/Fax

Practice location:
  • Phone: 407-355-0575
  • Fax: 407-355-0576
Mailing address:
  • Phone: 407-355-0575
  • Fax: 407-355-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME75973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: