Provider Demographics
NPI:1306167689
Name:JIMENEZ, ENRIQUE L (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:L
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ENRIQUE
Other - Middle Name:LUIS
Other - Last Name:JIMENEZ BORJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1400
Mailing Address - Fax:239-424-1421
Practice Address - Street 1:2776 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33902-2147
Practice Address - Country:US
Practice Address - Phone:239-343-2052
Practice Address - Fax:239-424-1421
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114377207R00000X
MO2017015053208M00000X
IN01079944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist