MEDICARE: JUAT GAN LIM

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	103K00000X	Behavior Analyst	1-21-56774	OK

General Provider Information

NPI Number	:	1659907202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAT GAN LIM

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

Provider Business Practice Location Address
First Line	:	11063-D S MEMORIAL DR STE 260
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-7362
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	03/16/2020
Last Update Date	:	07/14/2023

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Directions to “ JUAT GAN LIM ” Practice Location

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