Provider Demographics
NPI:1588647499
Name:LIM, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1800 RYAN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-6078
Mailing Address - Country:US
Mailing Address - Phone:337-439-4706
Mailing Address - Fax:337-439-8110
Practice Address - Street 1:1800 RYAN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6078
Practice Address - Country:US
Practice Address - Phone:337-439-4706
Practice Address - Fax:337-439-8110
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA09086R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA21035OtherCDS
300036292OtherRAILROAD MEDICARE
LA1930431Medicaid
LA1930431Medicaid
LA5N963Medicare ID - Type Unspecified
300036292OtherRAILROAD MEDICARE