Provider Demographics
NPI:1518985563
Name:JIMENEZ, LUIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:R
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8 PROSPECT ST
Mailing Address - Street 2:NORTH 2 SPECIALTY
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3925
Mailing Address - Country:US
Mailing Address - Phone:603-882-8375
Mailing Address - Fax:603-886-7163
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:NORTH 2 SPECIALTY
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3925
Practice Address - Country:US
Practice Address - Phone:603-882-8375
Practice Address - Fax:603-886-7163
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH14709208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2117784 05OtherUNITED HEALTH CARE
MEG88369OtherHARVARD PILGRIM
ME01/22/2008OtherHEALTHNET
ME3319013OtherATENA-HMO
ME7/1/2005OtherBENEFIT SERVICES
ME5719721OtherATENA-NON
MEM184993OtherCIGNA
ME105026OtherMARTINS POINT
ME3319013OtherATENA-HMO
ME01/22/2008OtherHEALTHNET
ME7/1/2005OtherBENEFIT SERVICES