Provider Demographics
NPI:1982070306
Name:JIMENEZ, ALFONSO (MD)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
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 1:3041 KNOTTY PINE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-1853
Mailing Address - Country:US
Mailing Address - Phone:646-893-9220
Mailing Address - Fax:406-226-0543
Practice Address - Street 1:5153 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:646-893-9220
Practice Address - Fax:406-226-0543
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168159251S00000X, 207R00000X, 208M00000X
NY296208208M00000X, 207R00000X
FLME164737208M00000X, 251S00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No251S00000XAgenciesCommunity/Behavioral Health
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist