Provider Demographics
NPI:1659375004
Name:DRUMMOND, JIMMIE JULIUS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:JULIUS
Last Name:DRUMMOND
Suffix:JR
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 1:12815 ODENS BEQUEST DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5615
Mailing Address - Country:US
Mailing Address - Phone:410-852-1134
Mailing Address - Fax:410-675-8947
Practice Address - Street 1:DILORENZO PENTAGON HEALTH CLINIC 5801 ARMY PENTAGON
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20310-5615
Practice Address - Country:US
Practice Address - Phone:703-692-8905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00378572083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E56053Medicare UPIN
S732Medicare ID - Type Unspecified
B069Medicare ID - Type Unspecified