Healthcare Provider Details

I. General information

NPI: 1598244055
Provider Name (Legal Business Name): JERONIMO LOPEZ MD SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5524 SW 45TH ST
OCALA FL
34474-9656
US

IV. Provider business mailing address

5524 SW 45TH ST
OCALA FL
34474-9656
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-9844
  • Fax:
Mailing address:
  • Phone: 352-732-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME120658
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME120658
License Number StateFL

VIII. Authorized Official

Name: JERONIMO LOPEZ
Title or Position: OWNER
Credential: MD
Phone: 352-732-9844