Provider Demographics
NPI:1336128958
Name:LIM, JUANITO Y (MD)
Entity Type:Individual
Prefix:DR
First Name:JUANITO
Middle Name:Y
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2500 CANYON RD BLDG D
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8624
Mailing Address - Country:US
Mailing Address - Phone:928-763-8600
Mailing Address - Fax:928-704-2201
Practice Address - Street 1:2500 CANYON RD BLDG D
Practice Address - Street 2:SUITE 1
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8624
Practice Address - Country:US
Practice Address - Phone:928-763-8600
Practice Address - Fax:928-704-2201
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31206207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831843Medicaid
AZ73922Medicare PIN
AZWDCDZMedicare PIN
AZE87722Medicare UPIN