MEDICARE: DR. RAUL E LOPEZ VERGE 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	207W00000X	Ophthalmology Physician	14569	PR

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	:	1780687962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL E LOPEZ VERGE MD

Provider Business Mailing Address
First Line	:	PO BOX 864
Second Line	:
City	:	SAN ANTONIO
State	:	PR
Zip	:	00690-0864
Country	:	US
Telephone Number	:	787-882-0592
Fax Number	:	787-882-0562

Provider Business Practice Location Address
First Line	:	0.3 CARR 110
Second Line	:	CEIBA BAJA
City	:	AGUADILLA
State	:	PR
Zip	:	00603
Country	:	US
Telephone Number	:	787-882-0592
Fax Number	:	787-882-0562

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/02/2024

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