MEDICARE: DR. FERNANDO LOPEZ M.D.

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	207W00000X	Ophthalmology Physician	036104977	IL
2	207W00000X	Ophthalmology Physician	ME80092	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013941657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO LOPEZ M.D.

Provider Business Mailing Address
First Line	:	1097 SW 42ND AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2639
Country	:	US
Telephone Number	:
Fax Number	:	888-845-1002

Provider Business Practice Location Address
First Line	:	1097 SW 42ND AVE FL 3
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-2639
Country	:	US
Telephone Number	:	305-442-2020
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/19/2024

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