Provider Demographics
NPI:1952365926
Name:LIM, ALFREDO T JR (PA-C)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:T
Last Name:LIM
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ALFREDO
Other - Middle Name:T
Other - Last Name:LIM
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:409 WINGBACK CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4869
Mailing Address - Country:US
Mailing Address - Phone:407-324-6901
Mailing Address - Fax:386-917-0655
Practice Address - Street 1:947 TOWN CENTER DR
Practice Address - Street 2:SUITE1341
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8361
Practice Address - Country:US
Practice Address - Phone:386-917-0075
Practice Address - Fax:386-917-0655
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6645ZMedicare ID - Type UnspecifiedMEDICARE NO
FLQ61250Medicare UPIN