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General NPI Number Information
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NPI Number | 1730174319
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Entity Type | Individual
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Provider Name | FERNANDO LOPEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 11399 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32825-5023
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Country | US
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Telephone | 407-207-6768
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Fax | 407-249-5025
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Provider Business Mailing Address
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Address Line | 1445 BROOKS LN
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City | OVIEDO
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State | FL
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Zip | 32765-8624
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Country | US
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Telephone | 407-207-6768
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Fax | 407-249-5025
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME45835
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License Number State | FL
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