Healthcare Provider Details

I. General information

NPI: 1972695914
Provider Name (Legal Business Name): JEFFREY M LIME MS PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W EUGIE 200
GLENDALE AZ
85304-1200
US

IV. Provider business mailing address

5605 W EUGIE 200
GLENDALE AZ
85304-1200
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-2991
  • Fax: 602-978-1226
Mailing address:
  • Phone: 602-843-2991
  • Fax: 602-978-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2206
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: