Provider Demographics
NPI:1518223809
Name:JIMENEZ LAWSON, AMANDA VILLALOBOS (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:VILLALOBOS
Last Name:JIMENEZ LAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:VILLALOBOS
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:751 HEBRON PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5070
Mailing Address - Country:US
Mailing Address - Phone:972-316-0450
Mailing Address - Fax:214-488-2762
Practice Address - Street 1:751 HEBRON PKWY STE 150
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5070
Practice Address - Country:US
Practice Address - Phone:972-316-0450
Practice Address - Fax:214-488-2762
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine