Provider Demographics
NPI:1942441746
Name:JIMENEZ, ALEXIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:A
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:A
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 734905
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4905
Mailing Address - Country:US
Mailing Address - Phone:904-449-7246
Mailing Address - Fax:904-719-7571
Practice Address - Street 1:4796 HODGES BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224
Practice Address - Country:US
Practice Address - Phone:904-449-7246
Practice Address - Fax:904-719-7571
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105097207LP2900X, 208VP0014X, 207LP2900X, 208VP0014X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009558100Medicaid
MNENROLLEDMedicaid
MN720000046Medicare PIN