Provider Demographics
NPI:1528381274
Name:JIMENEZ, PHILIP J (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 14TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6206
Mailing Address - Country:US
Mailing Address - Phone:214-210-2911
Mailing Address - Fax:214-210-2209
Practice Address - Street 1:1312 14TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6206
Practice Address - Country:US
Practice Address - Phone:214-210-2911
Practice Address - Fax:214-210-2209
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006334213ES0131X
TX3101213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX427781601Medicaid