Provider Demographics
NPI:1023047420
Name:LIM, DIANA MAGPAYO (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MAGPAYO
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 HOSPITAL DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2385
Mailing Address - Country:US
Mailing Address - Phone:318-212-7910
Mailing Address - Fax:318-212-7915
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 420
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-212-7910
Practice Address - Fax:318-212-7915
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11965R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1692026Medicaid
LA5Y197DB42Medicare PIN
LA5Y197Medicare PIN
B39733Medicare UPIN