Provider Demographics
NPI:1003011339
Name:JIMENEZ, LINCOLN M (MD)
Entity Type:Individual
Prefix:
First Name:LINCOLN
Middle Name:M
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 E JOHNSON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6065
Mailing Address - Country:US
Mailing Address - Phone:850-494-6003
Mailing Address - Fax:850-494-9636
Practice Address - Street 1:2130 E JOHNSON AVE STE 130
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6065
Practice Address - Country:US
Practice Address - Phone:850-494-6003
Practice Address - Fax:850-494-9636
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61014044207T00000X
FLME116162207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0225733Medicaid
KY7100471960Medicaid
WA1003011339Medicaid
GA003136606AMedicaid