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General NPI Number Information
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NPI Number | 1124006358
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Entity Type | Individual
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Provider Name | RAFAEL ROBERTO LOPEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 3347 STATE ROAD 7 SUITE 101
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City | WELLINGTON
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State | FL
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Zip | 33449-8095
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Country | US
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Telephone | 561-790-2111
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Fax | 561-790-0893
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS DEPT.
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City | FORT MYERS
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State | FL
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Zip | 33907-1412
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME58240
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License Number State | FL
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