Provider Demographics
NPI:1962496505
Name:JIMENEZ, CASEY (MD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12323 W COLONIAL DR STE 140
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4178
Mailing Address - Country:US
Mailing Address - Phone:407-318-7888
Mailing Address - Fax:407-236-1918
Practice Address - Street 1:12323 W COLONIAL DR STE 140
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4178
Practice Address - Country:US
Practice Address - Phone:407-318-7888
Practice Address - Fax:407-236-1918
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279402100Medicaid
FL279402100Medicaid