Individual
JASON PHILLIP JIMENEZ
Active
Individual
JASON PHILLIP JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00556
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12678940
CAQH
TX
01
—
85NN35
BCBSTX
TX
01
—
SA00556
LSA LICENSE
TX
Enumeration date
02/25/2007
Last updated
12/09/2022
Update your record
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