Provider Demographics
NPI:1881970770
Name:JESUS L JIMENEZ BARREDO MD PA
Entity type:Organization
Organization Name:JESUS L JIMENEZ BARREDO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:L
Authorized Official - Last Name:JIMENEZ BARREDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-944-1914
Mailing Address - Street 1:16520 NW 77TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3417
Mailing Address - Country:US
Mailing Address - Phone:517-944-1914
Mailing Address - Fax:786-558-4216
Practice Address - Street 1:16520 NW 77TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-3417
Practice Address - Country:US
Practice Address - Phone:517-944-1914
Practice Address - Fax:786-558-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101359207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME101359OtherFLORIDA LICENSE