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Individual
DR. SHANNON R. JIMENEZ
Active
Individual
DR. SHANNON R. JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
9900553
IA
207Q00000X
Family Medicine Physician
9900553
NC
207Q00000X
Family Medicine Physician
Primary
S4847
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0150C
BLUE CROSS GROUP #
NC
01
—
1215K
BLUE CROSS INDIVIDUAL
NC
05
—
790150C
—
NC
05
—
891215K
—
NC
Enumeration date
10/12/2006
Last updated
03/09/2020
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