Provider Demographics
NPI:1285603167
Name:LUM, DANIEL C (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
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:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-8450
Mailing Address - Fax:
Practice Address - Street 1:3200 W EULESS BLVD
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-6253
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:817-702-6493
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117495504Medicaid
TX8U1344OtherBCBS
TX117495504Medicaid
TX8D9284Medicare PIN