MEDICARE: J JULIAN LOPEZ INC

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	207RG0100X	Gastroenterology Physician	6073	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	100010704	OTHER	NV	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV0397	OTHER	NV	BCBS ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437235827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J JULIAN LOPEZ INC

Provider Business Mailing Address
First Line	:	PO BOX 35679
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5679
Country	:	US
Telephone Number	:	702-496-0991
Fax Number	:	702-877-6741

Provider Business Practice Location Address
First Line	:	7106 SMOKE RANCH RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8346
Country	:	US
Telephone Number	:	702-496-0991
Fax Number	:	702-877-6741

Authorized Official
Title or Position	:	OWNER
Name	:	DR. J JULIAN LOPEZ
Credential	:	M.D.
Telephone Number	:	702-496-0991

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	06/30/2011

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