Individual
DORIAN LOUIS JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1940 HWY 114 SUITE 150, SOUTHLAKE, TX 76092
(817) 424-3668
(817) 442-8637
Mailing address
1940 HWY 114 SUITE 150, SOUTHLAKE, TX 76092-3084
(817) 424-3668
(817) 442-8637
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
2397
TX
213E00000X
Podiatrist
POD000998
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
000998
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
582964905A
—
GA
01
—
P00427172
RAILROAD MEDICARE PTAN
GA
Enumeration date
09/23/2005
Last updated
07/17/2019
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