Provider Demographics
NPI:1922007673
Name:JIMENEZ, MAURICIO ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:ERNESTO
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N YARBROUGH DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-3240
Mailing Address - Country:US
Mailing Address - Phone:915-595-1844
Mailing Address - Fax:915-599-1953
Practice Address - Street 1:501 N YARBROUGH DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-3240
Practice Address - Country:US
Practice Address - Phone:915-595-1844
Practice Address - Fax:915-599-1953
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX264457YLPSOtherWELLMED PTAN
TX264457YL1WMedicare PIN
TXTXB113940Medicare PIN