MEDICARE: DR. JOSE AUDIE LIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	K4486	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0035KL	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1548379696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE AUDIE LIM M.D.

Provider Business Mailing Address
First Line	:	1209 BROOK AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5601
Country	:	US
Telephone Number	:	940-767-5111
Fax Number	:	940-767-5011

Provider Business Practice Location Address
First Line	:	1209 BROOK AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5601
Country	:	US
Telephone Number	:	940-767-5111
Fax Number	:	940-767-5011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/09/2007

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