Provider Demographics
NPI:1215937297
Name:LIM, RUTH G MOSQUEDA (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:G MOSQUEDA
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:SD
Mailing Address - Zip Code:57349-0099
Mailing Address - Country:US
Mailing Address - Phone:605-772-4574
Mailing Address - Fax:
Practice Address - Street 1:100018TH ST SW
Practice Address - Street 2:SUITE 27
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350
Practice Address - Country:US
Practice Address - Phone:605-554-1015
Practice Address - Fax:605-554-1016
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDA55905Medicare UPIN