MEDICARE: ADOLFO LOPEZ MIERES 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	174400000X	Specialist	13883	PR
2	207R00000X	Internal Medicine Physician	13883	PR

General Provider Information

NPI Number	:	1629062609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADOLFO LOPEZ MIERES MD

Provider Business Mailing Address
First Line	:	COND CAMELOT
Second Line	:	APT 4302 CARR 842
City	:	SAN JUAN
State	:	PR
Zip	:	00926-9760
Country	:	US
Telephone Number	:	787-429-9211
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAN JUAN CITY HOSPITAL
Second Line	:	MEDICAL CENTER
City	:	SAN JUAN
State	:	PR
Zip	:	00911
Country	:	US
Telephone Number	:	787-765-5147
Fax Number	:

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	08/19/2014

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