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General NPI Number Information
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NPI Number | 1912533076
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Entity Type | Individual
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Provider Name | JASON O LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 2500 ROCKY MOUNTAIN AVE STE 100
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City | LOVELAND
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State | CO
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Zip | 80538-9004
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Country | US
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Telephone | 970-624-1800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 917770
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City | ORLANDO
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State | FL
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Zip | 32891-0001
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Country | US
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Telephone | 813-821-8038
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Fax | 813-974-0483
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 024865
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9117464
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0009136
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License Number State | CO
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