MEDICARE: JOSHUA RAY JIMENEZ MD

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	207R00000X	Internal Medicine Physician	314971	NY

General Provider Information

NPI Number	:	1437612942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA RAY JIMENEZ MD

Provider Business Mailing Address
First Line	:	783 FRANKLIN ST
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-9313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	783 FRANKLIN ST
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-9313
Country	:	US
Telephone Number	:	315-685-8988
Fax Number	:

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

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	08/19/2022

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