Provider Demographics
NPI:1871531137
Name:JIMENEZ, FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
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 1:60 COMPASS ISLAND
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2008
Mailing Address - Country:US
Mailing Address - Phone:954-771-6925
Mailing Address - Fax:954-938-2532
Practice Address - Street 1:3850 COCONUT CREEK PKWY
Practice Address - Street 2:STE 3
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1600
Practice Address - Country:US
Practice Address - Phone:954-675-1411
Practice Address - Fax:954-938-2532
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31545207RC0000X
FLME31545207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64594Medicare UPIN
FL93623Medicare ID - Type Unspecified