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NPI Code Detail

MEDICARE: RAUL A LOPEZ M.D.

MEDICARE: RAUL A LOPEZ M.D.
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
1207RC0000XCardiovascular Disease PhysicianME51050FL

General Provider Information

NPI Number : 1790781219
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAUL A LOPEZ M.D.
Provider Business Mailing Address
First Line : 1324 LAKELAND HILLS BLVD
Second Line : ATTN: MEDICAL STAFF OFFICE
City : LAKELAND
State : FL
Zip : 33805-4543
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 130 PABLO ST
Second Line :
City : LAKELAND
State : FL
Zip : 33803-3818
Country : US
Telephone Number : 863-284-5941
Fax Number : 863-284-5199
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 07/29/2015

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Directions to “ RAUL A LOPEZ M.D.” Practice Location

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