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NPI Code Detail

MEDICARE: LUIS R. LOPEZ M.D., LTD

MEDICARE: LUIS R. LOPEZ M.D., LTD
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
1261QP2300XPrimary Care Clinic/Center12246AZ

General Provider Information

NPI Number : 1023348604
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUIS R. LOPEZ M.D., LTD
Provider Business Mailing Address
First Line : 521 W THOMAS RD FL 1
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4226
Country : US
Telephone Number : 602-631-4090
Fax Number : 602-631-4093
Provider Business Practice Location Address
First Line : 3330 N 2ND ST STE 400
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2371
Country : US
Telephone Number : 602-631-4090
Fax Number : 602-631-4093
Authorized Official
Title or Position : BUSINESS ADMINISTRATOR
Name : MR. LUIS RAUL LOPEZ JR.
Credential :
Telephone Number : 602-631-9873
Provider Enumeration Date : 01/05/2010
Last Update Date : 12/18/2024

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