Provider Demographics
NPI:1144510389
Name:LIM, ELSON TAN (MD)
Entity type:Individual
Prefix:DR
First Name:ELSON
Middle Name:TAN
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 1:1031 5TH STREET
Mailing Address - Street 2:PO BOX 13780
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58208-3780
Mailing Address - Country:US
Mailing Address - Phone:701-662-9670
Mailing Address - Fax:
Practice Address - Street 1:1031 5TH STREET
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58208-3780
Practice Address - Country:US
Practice Address - Phone:701-662-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND11939207Q00000X
IN01069427A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine