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General NPI Number Information
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NPI Number | 1659352631
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Entity Type | Individual
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Provider Name | JUAN JIMENEZ MD
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 452 AVE HOSTOS URB EL VEDADO
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City | SAN JUAN
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State | PR
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Zip | 00918-3015
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Country | US
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Telephone | 787-753-7980
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Fax | 787-753-7960
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Provider Business Mailing Address
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Address Line | D20 CALLE QUEBRADA ARENAS URB EL PILAR
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City | SAN JUAN
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State | PR
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Zip | 00926-5451
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Country | US
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Telephone | 787-758-7245
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Fax | 787-753-7960
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 6946
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License Number State | PR
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