Provider Demographics
NPI:1396740650
Name:JIMENEZ, ALFREDO (MD)
Entity type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18100 ST. JOHN DRIVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-0451
Mailing Address - Country:US
Mailing Address - Phone:281-335-7755
Mailing Address - Fax:281-335-7766
Practice Address - Street 1:18100 ST. JOHN DRIVE
Practice Address - Street 2:SUITE 240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-0451
Practice Address - Country:US
Practice Address - Phone:281-335-7755
Practice Address - Fax:281-335-7766
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4653207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10023864OtherAMERIGROUP
TX8K6340OtherBLUE CROSS/BLUE SHIELD
TX045240103Medicaid
TX0029KVOtherBLUE CROSS/BLUE SHIELD
TX045240104Medicaid
TX163317401OtherMEDICAID
F68110Medicare UPIN
TX0029KVOtherBLUE CROSS/BLUE SHIELD
TX8B3757Medicare PIN