MEDICARE: DR. JUANITO Y LIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	31206	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336128958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUANITO Y LIM MD

Provider Business Mailing Address
First Line	:	2500 CANYON RD BLDG D
Second Line	:	SUITE 1
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8624
Country	:	US
Telephone Number	:	928-763-8600
Fax Number	:	928-704-2201

Provider Business Practice Location Address
First Line	:	2500 CANYON RD BLDG D
Second Line	:	SUITE 1
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8624
Country	:	US
Telephone Number	:	928-763-8600
Fax Number	:	928-704-2201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	01/07/2014

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