Provider Demographics
NPI:1093711285
Name:LIM, SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3044 OLD DENTON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5016
Mailing Address - Country:US
Mailing Address - Phone:972-245-2876
Mailing Address - Fax:972-905-7487
Practice Address - Street 1:3044 OLD DENTON RD
Practice Address - Street 2:SUITE 115
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5016
Practice Address - Country:US
Practice Address - Phone:972-245-2876
Practice Address - Fax:972-905-7487
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL2988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151791404Medicaid
TX151791401Medicaid
TX151791406Medicaid
TX151791401Medicaid
TX151791404Medicaid
TX151791401Medicaid
TX00607QMedicare PIN