Provider Demographics
NPI:1366484040
Name:JIMENEZ, RICHARD ALAN HOUDEK (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN HOUDEK
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1909 214TH ST SE STE 211
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4418
Mailing Address - Country:US
Mailing Address - Phone:425-248-2626
Mailing Address - Fax:425-248-2627
Practice Address - Street 1:1909 214TH ST SE STE 211
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4418
Practice Address - Country:US
Practice Address - Phone:425-248-2626
Practice Address - Fax:425-248-2627
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016027207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1010487Medicaid
A04805Medicare UPIN
WA1010487Medicaid