MEDICARE: DR. JOSE A 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	207R00000X	Internal Medicine Physician	ME86165	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	:	1306882196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE A LOPEZ MD

Provider Business Mailing Address
First Line	:	30 REMINGTON RD STE 2
Second Line	:
City	:	OAKLAND
State	:	FL
Zip	:	34787-9797
Country	:	US
Telephone Number	:	407-392-1919
Fax Number	:	407-392-1917

Provider Business Practice Location Address
First Line	:	30 REMINGTON RD STE 2
Second Line	:
City	:	OAKLAND
State	:	FL
Zip	:	34787-9797
Country	:	US
Telephone Number	:	407-392-1919
Fax Number	:	407-392-1917

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	10/16/2014

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