Healthcare Provider Details

I. General information

NPI: 1629069521
Provider Name (Legal Business Name): JOSE A LIMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6444 CECIL AVE
SAINT LOUIS MO
63105-2225
US

IV. Provider business mailing address

6444 CECIL AVE
SAINT LOUIS MO
63105-2225
US

V. Phone/Fax

Practice location:
  • Phone: 314-348-8400
  • Fax:
Mailing address:
  • Phone: 314-348-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2024008010
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: