Provider Demographics
NPI:1861428542
Name:ESPEJO, EVALYNNE JIMENEZ (MD)
Entity type:Individual
Prefix:DR
First Name:EVALYNNE
Middle Name:JIMENEZ
Last Name:ESPEJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CLEMENT J ZABLOCKI VA MEDICAL CTR
Mailing Address - Street 2:5000 W. NATIONAL AV.
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295-0001
Mailing Address - Country:US
Mailing Address - Phone:414-384-2000
Mailing Address - Fax:414-389-4187
Practice Address - Street 1:CLEMENT J ZABLOCKI VA MEDICAL CTR
Practice Address - Street 2:5000 W. NATIONAL AV.
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-389-4187
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42052-020207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology