MEDICARE: JUSTIN LIMTONG

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	390200000X	Student in an Organized Health Care Education/Training Program	UO5601	FL
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	OS18711	FL
3	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	DO3399	NV

General Provider Information

NPI Number	:	1780190264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN LIMTONG

Provider Business Mailing Address
First Line	:	1600 S ANDREWS AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9499 W CHARLESTON BLVD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7147
Country	:	US
Telephone Number	:	702-933-9393
Fax Number	:

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

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	02/04/2026

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Directions to “ JUSTIN LIMTONG ” Practice Location

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