MEDICARE: DR. ANDREW MARK LUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	WA MD00045147	WA

General Provider Information

NPI Number	:	1659384196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW MARK LUM M.D.

Provider Business Mailing Address
First Line	:	14110 SE ALDRIDGE RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97236-6510
Country	:	US
Telephone Number	:	503-558-8263
Fax Number	:	503-813-2980

Provider Business Practice Location Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2023
Country	:	US
Telephone Number	:	503-813-2800
Fax Number	:	503-813-2980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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