Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME84808 | FL |
NPI | 1003975509 |
---|---|
Provider Name | Dr. Jesus Gil Jimenez |
First Address | Boynton Beach, FL 33435-7960 |
Second Address | Boynton Beach, FL 33435-7960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 03/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17013 | BLUE CROSS BLUE SHEILD (01) | FL |
264435500 | (05) | FL |
H59485 | (02) | FL |