Healthcare Provider Details

I. General information

NPI: 1649267923
Provider Name (Legal Business Name): RAUL A. JIMENEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 FIVAY RD STE 310
HUDSON FL
34667-7180
US

IV. Provider business mailing address

2055 LITTLE ROAD
TRINITY FL
34655
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-3202
  • Fax: 727-862-2182
Mailing address:
  • Phone: 727-862-3202
  • Fax: 727-862-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME62750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: