Provider Demographics
NPI:1245359132
Name:LUM, BRIAN DAVID (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
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 1:805 W WADE HAMPTON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1311
Mailing Address - Country:US
Mailing Address - Phone:864-655-6615
Mailing Address - Fax:855-617-4423
Practice Address - Street 1:805 W WADE HAMPTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1311
Practice Address - Country:US
Practice Address - Phone:864-655-6615
Practice Address - Fax:855-617-4423
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20203207Q00000X
NC2019-00062207Q00000X
TN52174207Q00000X
AK126620207Q00000X
SC28309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC4927L064OtherMEDICARE
MS05072043Medicaid
SCPENDINGMedicaid
SC283099Medicaid
SCAA20983361 SCMedicare PIN