Provider Demographics
NPI:1962496505
Name:JIMENEZ, CASEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 US HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-8653
Mailing Address - Country:US
Mailing Address - Phone:941-729-4400
Mailing Address - Fax:941-729-4424
Practice Address - Street 1:8342 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8653
Practice Address - Country:US
Practice Address - Phone:813-636-2000
Practice Address - Fax:813-286-8835
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279402100Medicaid
FL279402100Medicaid