Healthcare Provider Details

I. General information

NPI: 1750327250
Provider Name (Legal Business Name): FEDERICO J JIMENEZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 DOUGHERTY FERRY RD
SAINT LOUIS MO
63122-3313
US

IV. Provider business mailing address

2345 DOUGHERTY FERRY RD
SAINT LOUIS MO
63122-3313
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-5850
  • Fax:
Mailing address:
  • Phone: 314-821-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number35897
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: