Provider Demographics
NPI:1134161227
Name:LIM, STANLEY W (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:W
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 HOLLISTER ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-6100
Mailing Address - Country:US
Mailing Address - Phone:713-461-3573
Mailing Address - Fax:713-468-1247
Practice Address - Street 1:5301 HOLLISTER ST
Practice Address - Street 2:SUITE 350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-6100
Practice Address - Country:US
Practice Address - Phone:713-461-3573
Practice Address - Fax:713-468-1247
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL37322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176757605Medicaid
I19854Medicare UPIN
8K0259Medicare PIN