Provider Demographics
NPI:1154326585
Name:TIU, DWIGHT PETER LIM (MD)
Entity type:Individual
Prefix:DR
First Name:DWIGHT PETER
Middle Name:LIM
Last Name:TIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12 FLOYD CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8301
Mailing Address - Country:US
Mailing Address - Phone:386-328-5437
Mailing Address - Fax:386-447-7348
Practice Address - Street 1:1 FLORIDA PARK DR N
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3852
Practice Address - Country:US
Practice Address - Phone:904-728-6934
Practice Address - Fax:386-251-0943
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0075674208000000X
FLME75674207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43808OtherBCBS
FL254779100Medicaid
FL108985Medicare Oscar/Certification
FL254779100Medicaid