Provider Demographics
NPI:1366559098
Name:LUM, DON (MD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:
Last Name:LUM
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 1:4301 S MULBERRY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7017
Mailing Address - Country:US
Mailing Address - Phone:870-541-0400
Mailing Address - Fax:
Practice Address - Street 1:4301 S MULBERRY ST
Practice Address - Street 2:SUITE B
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7017
Practice Address - Country:US
Practice Address - Phone:870-541-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4730207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53240Medicare ID - Type Unspecified
ARD04740Medicare UPIN