1780675637 NPI number — JAYTON A LIM M.D.

Table of content: JAYTON A LIM M.D. (NPI 1780675637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780675637 NPI number — JAYTON A LIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIM
Provider First Name:
JAYTON
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780675637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17930
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72222-7930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-663-0490
Provider Business Mailing Address Fax Number:
501-663-5948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 LILE CT
Provider Second Line Business Practice Location Address:
SUITE 102B
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-224-8810
Provider Business Practice Location Address Fax Number:
501-224-9076
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  E-0461 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 127889001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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