Healthcare Provider Details

I. General information

NPI: 1336482843
Provider Name (Legal Business Name): MICHAEL RAFAEL LOPEZ-MOLINA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MORTON PLANT ST STE 405
CLEARWATER FL
33756-3394
US

IV. Provider business mailing address

430 MORTON PLANT ST STE 405
CLEARWATER FL
33756-3394
US

V. Phone/Fax

Practice location:
  • Phone: 727-443-0611
  • Fax: 727-461-5493
Mailing address:
  • Phone: 727-443-0611
  • Fax: 727-461-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127731
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME127731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: