Provider Demographics
NPI:1225049141
Name:LIM, VICTORIA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:LYNN
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5960 GETWELL ROAD
Mailing Address - Street 2:SUITE 212D
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7320
Mailing Address - Country:US
Mailing Address - Phone:662-895-6455
Mailing Address - Fax:662-895-6460
Practice Address - Street 1:5625 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3816
Practice Address - Country:US
Practice Address - Phone:901-761-1220
Practice Address - Fax:901-763-4332
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000031541207Y00000X
MS16412207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121592Medicaid
H02748Medicare UPIN
MSH02748Medicare UPIN
MS00121592Medicaid
MS040000180Medicare ID - Type Unspecified