Provider Demographics
NPI:1407828742
Name:LIM, NELSON (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
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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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1281 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2949
Practice Address - Country:US
Practice Address - Phone:520-876-0150
Practice Address - Fax:850-421-3474
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM96-310207RH0003X
AZ37111207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
850313268002OtherCHAMPUS
AZ7603494OtherAETNA & COFINITY PROVIDER NUMBER
P00070111OtherRAILROAD MEDICARE
NMNM000814OtherBCBS
NM201005896OtherPRESBYTERIAN HEALTH/SALUD
NM10002104OtherLOVELACE HEALTH/SALUD
NMK3929Medicaid
AZ362012Medicaid
NMPROVP14672OtherMOLINA
FLP00741630OtherRAILROAD MEDICARE
NMPROVP14672OtherMOLINA
NM10002104OtherLOVELACE HEALTH/SALUD
NMK3929Medicaid
NMNM000814OtherBCBS