Provider Demographics
NPI:1659548626
Name:JAIMES, JUAN P (MD, MS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:P
Last Name:JAIMES
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 PLATO BLVD E
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1827
Mailing Address - Country:US
Mailing Address - Phone:651-209-1600
Mailing Address - Fax:651-291-9169
Practice Address - Street 1:587 BIELENBERG DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4451
Practice Address - Country:US
Practice Address - Phone:651-578-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN52466207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1659548626Medicaid
MN070000929Medicare PIN