Provider Demographics
NPI:1780675637
Name:LIM, JAYTON A (MD)
Entity Type:Individual
Prefix:
First Name:JAYTON
Middle Name:A
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 17930
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72222-7930
Mailing Address - Country:US
Mailing Address - Phone:501-663-0490
Mailing Address - Fax:501-663-5948
Practice Address - Street 1:2 LILE CT
Practice Address - Street 2:SUITE 102B
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6221
Practice Address - Country:US
Practice Address - Phone:501-224-8810
Practice Address - Fax:501-224-9076
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-0461207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127889001Medicaid
G14225Medicare UPIN
ARP00354486Medicare PIN
AR5J872Medicare PIN