Healthcare Provider Details

I. General information

NPI: 1427366475
Provider Name (Legal Business Name): GEORGE T. LIM JR, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 NW 84TH AVE
SUNRISE FL
33351-6607
US

IV. Provider business mailing address

3505 NW 84TH AVE
SUNRISE FL
33351-6607
US

V. Phone/Fax

Practice location:
  • Phone: 954-748-3039
  • Fax: 954-748-5358
Mailing address:
  • Phone: 954-748-3039
  • Fax: 954-748-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME53050
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGE T LIM JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-804-0894