Healthcare Provider Details

I. General information

NPI: 1659548626
Provider Name (Legal Business Name): JUAN P JAIMES M.D., M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 BIELENBERG DR SUITE 200
WOODBURY MN
55125-4451
US

IV. Provider business mailing address

60 PLATO BLVD E SUITE 270
SAINT PAUL MN
55107-1827
US

V. Phone/Fax

Practice location:
  • Phone: 651-578-2700
  • Fax:
Mailing address:
  • Phone: 651-209-1600
  • Fax: 651-291-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number52466
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: