Provider Demographics
NPI:1053396838
Name:VALDES, PEDRO JIMENEZ (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:JIMENEZ
Last Name:VALDES
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:PO BOX 84564
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5864
Mailing Address - Country:US
Mailing Address - Phone:907-258-4430
Mailing Address - Fax:907-258-4435
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:STE C-416
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-258-4430
Practice Address - Fax:907-258-4435
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK3443208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1611Medicaid
DC1725OtherRAILROAD MEDICARE
0000WFBKKOtherMCARE ACS GRP
AKOOWFBKKAMedicare ID - Type Unspecified
AKMD1611Medicaid