Provider Demographics
NPI:1386848950
Name:JIMENEZ, CARLOS JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:JAVIER
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:815 MARKET ST
Mailing Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN - GALVESTON
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-2725
Mailing Address - Country:US
Mailing Address - Phone:409-770-6731
Mailing Address - Fax:409-770-6919
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:UNIVERSITY OF TEXAS MEDICAL BRANCH
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1220
Practice Address - Country:US
Practice Address - Phone:409-772-9066
Practice Address - Fax:409-747-7319
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2016-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXTEMP2086S0102X
TXN01352086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193225301Medicaid
3881617185OtherMYUTMB 3881617185-COMMERCIAL NUMBER