Healthcare Provider Details

I. General information

NPI: 1457349383
Provider Name (Legal Business Name): MARTIN J LOPEZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 S KLEIN AVE STE 900
OKLAHOMA CITY OK
73109-3845
US

IV. Provider business mailing address

PO BOX 1772
NORMAN OK
73070-1772
US

V. Phone/Fax

Practice location:
  • Phone: 405-631-0300
  • Fax: 405-631-0371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number16998
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number16998
License Number StateOK

VIII. Authorized Official

Name: DR. MARTIN J LOPEZ
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 405-631-0300