MEDICARE: DR. MARTIN J LOPEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	16998	OK
2	208VP0014X	Interventional Pain Medicine Physician	16998	OK
3	207L00000X	Anesthesiology Physician	16998	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	050032793	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4460958	OTHER	OK	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013905942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN J LOPEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 99730
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73199-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 S KLEIN AVE
Second Line	:	STE 900
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3845
Country	:	US
Telephone Number	:	405-636-1797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	01/07/2020

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