Provider Demographics
NPI:1386870459
Name:NELSON H. LIM MD, LLC
Entity type:Organization
Organization Name:NELSON H. LIM MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:H
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-722-9788
Mailing Address - Street 1:2563 S VAL VISTA DR
Mailing Address - Street 2:STE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1804
Mailing Address - Country:US
Mailing Address - Phone:480-722-9788
Mailing Address - Fax:480-722-9789
Practice Address - Street 1:2563 S VAL VISTA DR
Practice Address - Street 2:STE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1804
Practice Address - Country:US
Practice Address - Phone:480-722-9788
Practice Address - Fax:480-722-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42036207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ42036OtherAZ LIC