Provider Demographics
NPI:1982647376
Name:LIM, RODOLFO E (MD)
Entity Type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:E
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3716 PRIVATEWOOD RD S
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6526
Mailing Address - Country:US
Mailing Address - Phone:870-879-4645
Mailing Address - Fax:
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6900
Practice Address - Country:US
Practice Address - Phone:870-534-8651
Practice Address - Fax:870-534-2827
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC59162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE17155Medicare UPIN
AR53575Medicare ID - Type Unspecified