Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G70430 | CA |
N | 207PE0004X | Emergency Medical Services | G70430 | CA |
NPI | 1073561684 |
---|---|
Provider Name | George P. Lum |
First Address | Templeton, CA 93465-0087 |
Second Address | Templeton, CA 93465-9704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 24/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G704300 | (05) | CA |
F66466 | (02) | CA |