Healthcare Provider Details

I. General information

NPI: 1699765636
Provider Name (Legal Business Name): JOSE R JIMENEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 US HIGHWAY 98 W SUITE 350
MIRAMAR BEACH FL
32550-7230
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-622-3393
  • Fax: 850-622-3371
Mailing address:
  • Phone: 850-475-4500
  • Fax: 850-475-4781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME62240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: