Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | C4730 | AR |
NPI | 1366559098 |
---|---|
Provider Name | Dr. Don Lum |
First Address | Pine Bluff, AR 71603-7017 |
Second Address | Pine Bluff, AR 71603-7017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 10/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D04740 | (02) | AR |