Individual
TEODORO JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
217 S 3RD ST, DANVILLE, KY 40422-1823
(859) 335-9041
(859) 335-9072
Mailing address
PO BOX 1650, AKRON, OH 44309-1650
(330) 864-8900
(330) 869-8924
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
11737
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000384514
ANTHEM
KY
05
—
0055978000
—
WV
01
—
3000130
BWC
WV
05
—
4401035
—
TN
01
—
P00212626
RR-MEDICARE
KY
Enumeration date
07/16/2006
Last updated
07/09/2007
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