Provider Demographics
NPI:1093788549
Name:JIMENEZ, JAMES MARCUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARCUS
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 1:12671 US HWY 98 WEST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32550-8304
Mailing Address - Country:US
Mailing Address - Phone:850-837-4043
Mailing Address - Fax:850-837-5245
Practice Address - Street 1:12671 EMERALD COAST PKWY W UNIT 210
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32550-8304
Practice Address - Country:US
Practice Address - Phone:850-837-4043
Practice Address - Fax:850-837-5245
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME828242085R0204X, 2085R0202X, 2085R0204X
AL000258092085R0204X, 2085R0202X
GA0444992085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051504364OtherIDTF
AL000058867OtherIDTF
AL009990565Medicaid
AL009990595Medicaid
FL262664100Medicaid
AL009990645Medicaid
AL009992765Medicaid
AL009990575Medicaid
AL009990585Medicaid
AL009990655Medicaid
AL009990605Medicaid
AL009990625Medicaid
AL009990665Medicaid
AL009992755Medicaid
AL051504364OtherIDTF
AL009990625Medicaid
AL009990605Medicaid
AL009990635Medicaid
AL009990585Medicaid
AL009990575Medicaid