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General NPI Number Information
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NPI Number | 1508881889
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Entity Type | Individual
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Provider Name | FERNANDO M LOPEZ-IVERN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 9980 CENTRAL PARK BLVD N SUITE 116
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City | BOCA RATON
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State | FL
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Zip | 33428-1762
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Country | US
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Telephone | 561-893-0651
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Fax | 561-893-0655
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Provider Business Mailing Address
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Address Line | 9980 CENTRAL PARK BLVD N SUITE 116
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City | BOCA RATON
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State | FL
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Zip | 33428-1762
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Country | US
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Telephone | 561-893-0651
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Fax | 561-893-0655
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 37131
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License Number State | FL
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