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General NPI Number Information
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NPI Number | 1154326585
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Entity Type | Individual
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Provider Name | DWIGHT PETER LIM TIU M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1 FLORIDA PARK DR N
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City | PALM COAST
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State | FL
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Zip | 32137-3852
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Country | US
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Telephone | 904-728-6934
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Fax | 386-251-0943
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Provider Business Mailing Address
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Address Line | 12 FLOYD CT
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City | PALM COAST
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State | FL
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Zip | 32137-8301
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Country | US
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Telephone | 386-328-5437
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Fax | 386-447-7348
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME0075674
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | ME75674
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License Number State | FL
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