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NPI Code Detail

MEDICARE: PEDRO JUAN LOPEZ M.D.

MEDICARE: PEDRO JUAN LOPEZ 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
1207R00000XInternal Medicine Physician11556PR

General Provider Information

NPI Number : 1649276601
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEDRO JUAN LOPEZ M.D.
Provider Business Mailing Address
First Line : 920 LANTERN LN
Second Line :
City : WEATHERFORD
State : OK
Zip : 73096-5820
Country : US
Telephone Number : 580-774-2835
Fax Number :
Provider Business Practice Location Address
First Line : RR 1 BOX 3060
Second Line :
City : CLINTON
State : OK
Zip : 73601-9303
Country : US
Telephone Number : 580-331-3340
Fax Number : 580-331-3349
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 11/15/2010

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