Provider Demographics
NPI:1891733184
Name:JIMENEZ, JOHN LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
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 1:45 NE LOOP 410
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5831
Mailing Address - Country:US
Mailing Address - Phone:210-375-7790
Mailing Address - Fax:210-979-9686
Practice Address - Street 1:45 NE LOOP 410
Practice Address - Street 2:SUITE 900
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5831
Practice Address - Country:US
Practice Address - Phone:210-375-7790
Practice Address - Fax:210-979-9686
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0076207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127649506Medicaid
8F2838Medicare PIN
TX127649506Medicaid