MEDICARE: JOSEPH M LOPEZ MD PC

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	010011909	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	PR32757550001	OTHER	CIGNA HEALTHCARE
2	55181	OTHER	FEDERA BC BS
3	0004586257	OTHER	AETNA
4	000585011	OTHER	APWU HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	C09900002163	OTHER	SIERRA HEALTH & LIFE
8	120085BF	OTHER	PREFERRED ADMINISTRATIVE
9	33143	OTHER	ANTHEM BC BS
10	0135688	OTHER	MAIL HANDLERS BENEFIT PLA

General Provider Information

NPI Number	:	1104910181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH M LOPEZ MD PC

Provider Business Mailing Address
First Line	:	1136 E STUART ST
Second Line	:	SUITE 4202
City	:	FT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-221-5925
Fax Number	:	970-221-5012

Provider Business Practice Location Address
First Line	:	1136 E STUART ST
Second Line	:	SUITE 4202
City	:	FT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-221-5925
Fax Number	:	970-221-5012

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH M LOPEZ
Credential	:	MD
Telephone Number	:	970-221-5925

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/18/2008

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