Provider Demographics
NPI:1730247602
Name:JIMENEZ, JOSE DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DANIEL
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 47957
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-0117
Mailing Address - Country:US
Mailing Address - Phone:813-907-8001
Mailing Address - Fax:813-907-5744
Practice Address - Street 1:2527 WINDGUARD CIR
Practice Address - Street 2:SUITE #102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7347
Practice Address - Country:US
Practice Address - Phone:813-907-8001
Practice Address - Fax:813-907-5744
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME79938208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258877300Medicaid