Provider Demographics
NPI:1528398500
Name:DON LUM, M.D., P.A.
Entity Type:Organization
Organization Name:DON LUM, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-541-0400
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4730207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103001001Medicaid
AR53240Medicare PIN
D04740Medicare UPIN