Provider Demographics
NPI:1821002478
Name:JIMENEZ-OLIVA, JUAN M (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:JIMENEZ-OLIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:M
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8160 WALNUT HILL LN
Mailing Address - Street 2:SUITE 216
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4339
Mailing Address - Country:US
Mailing Address - Phone:214-368-2543
Mailing Address - Fax:214-373-8946
Practice Address - Street 1:8160 WALNUT HILL LN
Practice Address - Street 2:SUITE 216
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4339
Practice Address - Country:US
Practice Address - Phone:214-368-2543
Practice Address - Fax:214-373-8946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9513207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7830OtherBLUE CROSS, BLUE SHIELD
TXB23764Medicare UPIN