MEDICARE: DR. LUIS JIMENEZ X M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	138818	NY

General Provider Information

NPI Number	:	1295855005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS JIMENEZ X M.D.

Provider Business Mailing Address
First Line	:	PO BOX 743
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-0596
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1265 FRANKLIN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3501
Country	:	US
Telephone Number	:	718-503-7700
Fax Number	:	718-503-7712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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