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NPI Code Detail

MEDICARE: DR. LUIS RAUL LOPEZ M.D.

MEDICARE: DR. LUIS RAUL 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
1207Q00000XFamily Medicine Physician12246AZ

General Provider Information

NPI Number : 1821148917
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUIS RAUL LOPEZ M.D.
Provider Business Mailing Address
First Line : 3330N 2ND ST 400
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2371
Country : US
Telephone Number : 602-631-9873
Fax Number : 602-631-4093
Provider Business Practice Location Address
First Line : 3330N 2ND ST 400
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2371
Country : US
Telephone Number : 602-631-9873
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2007
Last Update Date : 10/08/2015

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