Provider Demographics
NPI:1326232356
Name:DA ROCHA LIMA, BRENO (MD)
Entity Type:Individual
Prefix:
First Name:BRENO
Middle Name:
Last Name:DA ROCHA LIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRENO
Other - Middle Name:DA ROCHA
Other - Last Name:LIMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7205 BONNEVAL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7565
Mailing Address - Country:US
Mailing Address - Phone:904-296-0098
Mailing Address - Fax:
Practice Address - Street 1:7205 BONNEVAL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7565
Practice Address - Country:US
Practice Address - Phone:904-296-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA189939390200000X
OH390200000X
MDD74033207W00000X
FLME117136207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program