Basic Information
| Provider Information | |||||||||
| NPI: | 1932722725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIMENEZ STUART | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | MISHEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 W 24TH ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165022665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144525101 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 311 W 24TH ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165022665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144525101 | ||||||||
| FaxNumber: | 8144525097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2020 | ||||||||
| LastUpdateDate: | 05/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OT020178 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.