Provider Demographics
NPI:1174055115
Name:JIMENEZ-RUIZ, FEDERICO (MD)
Entity type:Individual
Prefix:
First Name:FEDERICO
Middle Name:
Last Name:JIMENEZ-RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 11 SUR NO 29 D 300
Mailing Address - Street 2:APT 906
Mailing Address - City:MEDELLIN
Mailing Address - State:ANTIOQUIA
Mailing Address - Zip Code:050022
Mailing Address - Country:CO
Mailing Address - Phone:786-223-6973
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1623
Practice Address - Country:US
Practice Address - Phone:352-273-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152996207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117462000Medicaid