Healthcare Provider Details

I. General information

NPI: 1871526467
Provider Name (Legal Business Name): FERNANDO M LOPEZ-IVERN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 CENTRAL PARK BLVD N SUITE 116
BOCA RATON FL
33428-1762
US

IV. Provider business mailing address

9980 CENTRAL PARK BLVD N STE 116
BOCA RATON FL
33428-1703
US

V. Phone/Fax

Practice location:
  • Phone: 561-893-0651
  • Fax: 561-893-0655
Mailing address:
  • Phone: 561-448-1880
  • Fax: 561-893-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 37131
License Number StateFL

VIII. Authorized Official

Name: FERNANDO M LOPEZ
Title or Position: OWNER
Credential: M.D.
Phone: 561-893-0651