Provider Demographics
NPI:1083690366
Name:JIMENEZ, GILBERTO (MD)
Entity Type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
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 1:19346 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2752
Mailing Address - Country:US
Mailing Address - Phone:954-430-0838
Mailing Address - Fax:954-430-0838
Practice Address - Street 1:1435 W 49TH PL STE 306
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3147
Practice Address - Country:US
Practice Address - Phone:305-364-9949
Practice Address - Fax:305-364-0927
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLM82228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6040BMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
FLE6040CMedicare ID - Type Unspecified
FLH45957Medicare UPIN