Provider Demographics
NPI:1669904389
Name:SHUM, ALAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:SHUM
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 1:500 HARRISON ST
Mailing Address - Street 2:APT 1404
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3036
Mailing Address - Country:US
Mailing Address - Phone:917-435-9219
Mailing Address - Fax:
Practice Address - Street 1:500 HARRISON ST
Practice Address - Street 2:APT 1404
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3036
Practice Address - Country:US
Practice Address - Phone:917-435-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4874207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine