Provider Demographics
NPI:1780722348
Name:JULIE W LIM MD
Entity type:Organization
Organization Name:JULIE W LIM MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-774-3960
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018GCOtherBC
TX0018GCOtherBC