Basic Information
Provider Information
NPI: 1932147246
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JIMENEZ
FirstName: ALFREDO
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8440 WALNUT HILL LN
Address2: SUITE 700
City: DALLAS
State: TX
PostalCode: 752313833
CountryCode: US
TelephoneNumber: 2143613300
FaxNumber: 2143613431
Practice Location
Address1: 3600 GASTON AVE
Address2: SUITE 851
City: DALLAS
State: TX
PostalCode: 752461800
CountryCode: US
TelephoneNumber: 2148266044
FaxNumber: 2148237183
Other Information
ProviderEnumerationDate: 06/02/2006
LastUpdateDate: 12/01/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XK8770TXY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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