Provider Demographics
NPI:1558353094
Name:LIM, JAMES S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8089
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-8089
Mailing Address - Country:US
Mailing Address - Phone:239-643-1155
Mailing Address - Fax:239-643-9816
Practice Address - Street 1:1441 RIDGE ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4211
Practice Address - Country:US
Practice Address - Phone:239-643-1155
Practice Address - Fax:239-643-9816
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME637672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263064800Medicaid
FL300120804OtherRR MEDICARE
FL300120805OtherRR MEDICARE
FL263064800Medicaid
FL300120804OtherRR MEDICARE
FLB98187Medicare UPIN