MEDICARE: ERNESTO JAVIER JIMENO CHACIN 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	208000000X	Pediatrics Physician	34800R	PR
2	208000000X	Pediatrics Physician	U1302	TX

General Provider Information

NPI Number	:	1477119394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO JAVIER JIMENO CHACIN MD

Provider Business Mailing Address
First Line	:	12377 MERIT DR STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3126
Country	:	US
Telephone Number	:	787-844-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	9115 FM 723 RD STE 900
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-9236
Country	:	US
Telephone Number	:	281-742-0708
Fax Number	:

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

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	03/31/2023

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