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NPI Code Detail

MEDICARE: JESSE G LOPEZ MD

MEDICARE: JESSE G LOPEZ MD
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
1207L00000XAnesthesiology Physician35086107OH
2207L00000XAnesthesiology Physician64389AZ

General Provider Information

NPI Number : 1194714196
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE G LOPEZ MD
Provider Business Mailing Address
First Line : 5350 FRANTZ RD
Second Line :
City : DUBLIN
State : OH
Zip : 43016-4259
Country : US
Telephone Number : 614-544-6366
Fax Number : 614-544-6350
Provider Business Practice Location Address
First Line : 4605 E ELWOOD ST STE 500
Second Line :
City : PHOENIX
State : AZ
Zip : 85040-1978
Country : US
Telephone Number : 602-200-9021
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 08/18/2021

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Directions to “ JESSE G LOPEZ MD” Practice Location

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