Healthcare Provider Details

I. General information

NPI: 1629070339
Provider Name (Legal Business Name): ARQUIMEDES LOPES RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIAMI AVE
INDIALANTIC FL
32903-3519
US

IV. Provider business mailing address

200 MIAMI AVE
INDIALANTIC FL
32903-3519
US

V. Phone/Fax

Practice location:
  • Phone: 321-506-4830
  • Fax: 321-220-0566
Mailing address:
  • Phone: 321-506-4830
  • Fax: 321-220-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT00010923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: