Healthcare Provider Details

I. General information

NPI: 1730247602
Provider Name (Legal Business Name): JOSE DANIEL JIMENEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 WINDGUARD CIR SUITE #102
WESLEY CHAPEL FL
33544-7347
US

IV. Provider business mailing address

PO BOX 47957
TAMPA FL
33647-0117
US

V. Phone/Fax

Practice location:
  • Phone: 813-907-8001
  • Fax: 813-907-5744
Mailing address:
  • Phone: 813-907-8001
  • Fax: 813-907-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME79938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: