Healthcare Provider Details

I. General information

NPI: 1245547355
Provider Name (Legal Business Name): BALDIR A LOPEZ ACOSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 LEE BLVD SUITE 4
LEHIGH ACRES FL
33936-4852
US

IV. Provider business mailing address

1154 LEE BLVD SUITE 4
LEHIGH ACRES FL
33936-4852
US

V. Phone/Fax

Practice location:
  • Phone: 347-852-5705
  • Fax:
Mailing address:
  • Phone: 347-852-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME109802
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME109802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: