Provider Demographics
NPI:1629069521
Name:LIMA, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:LIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10004 KENEELY RD
Mailing Address - Street 2:STE 18313
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128
Mailing Address - Country:US
Mailing Address - Phone:314-843-8400
Mailing Address - Fax:314-843-8402
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:STE 183B
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-843-8400
Practice Address - Fax:314-840-8402
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOT9744207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA09570Medicare UPIN
MO009013883Medicare ID - Type Unspecified