Healthcare Provider Details

I. General information

NPI: 1962778597
Provider Name (Legal Business Name): ZACHARY CHRISTOPHER LUM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17842 NW 2ND ST
PEMBROKE PINES FL
33029-2806
US

IV. Provider business mailing address

1608 TOWN CENTER BLVD STE A
WESTON FL
33326-3639
US

V. Phone/Fax

Practice location:
  • Phone: 954-430-9901
  • Fax: 954-430-0608
Mailing address:
  • Phone: 954-349-2345
  • Fax: 954-349-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberOS17663
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS17663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: