Provider Demographics
NPI:1922033752
Name:LIM, JULIE W (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:W
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2801 E 29TH ST STE 117
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2619
Mailing Address - Country:US
Mailing Address - Phone:979-774-3960
Mailing Address - Fax:979-774-4506
Practice Address - Street 1:2801 E 29TH ST STE 117
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2619
Practice Address - Country:US
Practice Address - Phone:979-774-3960
Practice Address - Fax:979-774-4506
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018GCOtherBLUE CROSS NUMBER
TX030435401Medicaid
TXH28575Medicare UPIN
TX00490MMedicare ID - Type Unspecified