MEDICARE: DR. CARLOS FERNANDEZ-MAYMI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	6839	PR
2	208000000X	Pediatrics Physician	4301067245	MI
3	208000000X	Pediatrics Physician	ME145523	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346226644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS FERNANDEZ-MAYMI M.D.

Provider Business Mailing Address
First Line	:	305 MEMORIAL MEDICAL PKWY STE 405
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 MEMORIAL MEDICAL PKWY STE 405
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5169
Country	:	US
Telephone Number	:	989-584-3981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	06/29/2020

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Directions to “ DR. CARLOS FERNANDEZ-MAYMI M.D.” Practice Location

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