Healthcare Provider Details

I. General information

NPI: 1013914209
Provider Name (Legal Business Name): LANCE S LIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 1ST ST NE SUITE 1
WESSINGTON SPRINGS SD
57382-2134
US

IV. Provider business mailing address

602 1ST ST NE SUITE 1
WESSINGTON SPRINGS SD
57382-2134
US

V. Phone/Fax

Practice location:
  • Phone: 605-539-1767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5081
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: