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NPI Code Detail

MEDICARE: DR. JAIME JIMENEZ AGOSTO M.D.

MEDICARE: DR. JAIME JIMENEZ AGOSTO 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
1207W00000XOphthalmology Physician12372MS
2207W00000XOphthalmology PhysicianH8698TX
3207WX0107XRetina Specialist (Ophthalmology) Physician12372MS
4207WX0108XUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician12372MS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1512I180024OTHERMSMEDICARE PTAN FOR SOUTHERN EYE PHYSICIAN'S CENTER LLC
3512I180025OTHERMSMEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932102951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAIME JIMENEZ AGOSTO M.D.
Provider Business Mailing Address
First Line : 1420 S 28TH AVE
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-3107
Country : US
Telephone Number : 601-264-3937
Fax Number : 601-264-5930
Provider Business Practice Location Address
First Line : 1420 S 28TH AVE
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-3107
Country : US
Telephone Number : 601-264-3937
Fax Number : 601-264-5930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 04/05/2017

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