Provider Demographics
NPI:1326096256
Name:LUM, TREIS R (DO)
Entity Type:Individual
Prefix:MR
First Name:TREIS
Middle Name:R
Last Name:LUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12366 W. MILTON DR.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7614
Mailing Address - Country:US
Mailing Address - Phone:928-501-9581
Mailing Address - Fax:928-501-9582
Practice Address - Street 1:20950 N TATUM BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4200
Practice Address - Country:US
Practice Address - Phone:480-776-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1261208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E42840Medicare UPIN