Healthcare Provider Details

I. General information

NPI: 1538145891
Provider Name (Legal Business Name): JOEL R LOPES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 01/26/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 COVETED PL
YULEE FL
32097-3663
US

IV. Provider business mailing address

171 COVETED PL
YULEE FL
32097-3663
US

V. Phone/Fax

Practice location:
  • Phone: 617-721-7441
  • Fax:
Mailing address:
  • Phone: 617-721-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number320699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: