Provider Demographics
NPI:1487175063
Name:JIMENEZ, DENIS (MD)
Entity type:Individual
Prefix:
First Name:DENIS
Middle Name:
Last Name:JIMENEZ
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 1:1110 COLUMBINE DR
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8824
Mailing Address - Country:US
Mailing Address - Phone:785-364-2116
Mailing Address - Fax:785-364-9612
Practice Address - Street 1:1110 COLUMBINE DR
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8824
Practice Address - Country:US
Practice Address - Phone:785-364-2116
Practice Address - Fax:785-364-9612
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL51207208600000X
KS046648208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLL51207Medicaid