Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | MD61014044 | WA |
Y | 207T00000X | Neurosurgeon | ME116162 | FL |
NPI | 1003011339 |
---|---|
Provider Name | Lincoln M Jimenez |
First Address | Pensacola, FL 32514-6065 |
Second Address | Pensacola, FL 32514-6065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0225733 | (05) | OH |
1003011339 | (05) | WA |
7100471960 | (05) | KY |