Provider Demographics
NPI:1790274173
Name:JIMENEZ, JESUS ALFREDO (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ALFREDO
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:903 W MARTIN ST # MS 49-2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-0903
Mailing Address - Country:US
Mailing Address - Phone:210-358-3427
Mailing Address - Fax:210-358-5940
Practice Address - Street 1:15102 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1739
Practice Address - Country:US
Practice Address - Phone:210-644-2400
Practice Address - Fax:210-702-6980
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT4185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine