Healthcare Provider Details

I. General information

NPI: 1760011845
Provider Name (Legal Business Name): DANIEL JOSE LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5367 SPRING HILL DR
SPRING HILL FL
34606-4540
US

IV. Provider business mailing address

3913 AMERICANA DR
TAMPA FL
33634-7405
US

V. Phone/Fax

Practice location:
  • Phone: 352-600-6780
  • Fax: 352-600-6765
Mailing address:
  • Phone: 352-600-6780
  • Fax: 352-600-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME158773
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME158773
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME158773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: