MEDICARE: DR. GUSTAVO LOPES D.O.

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	208600000X	Surgery Physician	OS10182	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	:	1588863351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUSTAVO LOPES D.O.

Provider Business Mailing Address
First Line	:	PO BOX 20800
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4105
Country	:	US
Telephone Number	:	888-402-7256
Fax Number	:	888-902-1099

Provider Business Practice Location Address
First Line	:	900 SE BECKER RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-6641
Country	:	US
Telephone Number	:	772-255-7550
Fax Number	:	561-626-9804

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	03/25/2024

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