Provider Demographics
NPI:1568493443
Name:JIMENEZ, RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
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 1:302 W BASS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5001
Mailing Address - Country:US
Mailing Address - Phone:407-518-7999
Mailing Address - Fax:407-518-9766
Practice Address - Street 1:302 W BASS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5001
Practice Address - Country:US
Practice Address - Phone:407-518-7999
Practice Address - Fax:407-518-9766
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059612207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4380411OtherAETNA
FL06920OtherWELLCARE
2102311OtherGHI
FL4724188OtherCIGNA
FL10411101OtherCITRUS CARE
FL251215700Medicaid
FL251215700Medicaid
E95696Medicare UPIN
FL12488Medicare ID - Type Unspecified