Healthcare Provider Details

I. General information

NPI: 1720387822
Provider Name (Legal Business Name): JAIME C. LIM MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 9TH ST
WICHITA FALLS TX
76301-5003
US

IV. Provider business mailing address

1722 9TH ST
WICHITA FALLS TX
76301-5003
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-1075
  • Fax: 940-322-1056
Mailing address:
  • Phone: 940-322-1075
  • Fax: 940-322-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAIME C LIM
Title or Position: OWNER/SOLE MEMBER
Credential: M.D.
Phone: 940-322-1075