Provider Demographics
NPI:1821423120
Name:MOGOLLON PAREDES, JAIME EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:EDUARDO
Last Name:MOGOLLON PAREDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1065 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2417
Mailing Address - Country:US
Mailing Address - Phone:718-589-2440
Mailing Address - Fax:718-991-4516
Practice Address - Street 1:1065 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:718-589-2440
Practice Address - Fax:718-991-4516
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2018-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY294499207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease