Healthcare Provider Details

I. General information

NPI: 1518353168
Provider Name (Legal Business Name): JORGE ALBERTO JIMENEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10202 JEFFERSON HWY STE D
BATON ROUGE LA
70809-3183
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 225-768-8833
  • Fax: 225-769-4839
Mailing address:
  • Phone: 614-293-8116
  • Fax: 614-293-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35135633
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number35135633
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number325976
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: