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General NPI Number Information
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NPI Number | 1942472949
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Entity Type | Organization
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Legal Business Name | DR. RAPHAEL LOPEZ, LLC
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 131 WEBB DR SUITE C
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City | DAVENPORT
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State | FL
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Zip | 33837-3921
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Country | US
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Telephone | 321-939-4268
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 ROYCROFT AVE
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City | CELEBRATION
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State | FL
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Zip | 34747-4016
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Country | US
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Telephone | 321-939-4268
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. RAPHAEL LUIS LOPEZ
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Credential | M.D.
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Telephone | 321-939-4268
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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 | ME85048
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License Number State | FL
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