Individual
DR. JAIME JIMENEZ AGOSTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
12372
MS
207W00000X
Ophthalmology Physician
H8698
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
12372
MS
207WX0108X
Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
12372
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115830
—
MS
01
—
512I180024
MEDICARE PTAN FOR SOUTHERN EYE PHYSICIAN'S CENTER LLC
MS
01
—
512I180025
MEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC
MS
Enumeration date
05/23/2005
Last updated
04/05/2017
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