MEDICARE: DR. LUIS ERIC LOPEZ

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	207R00000X	Internal Medicine Physician	ME122266	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841433687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ERIC LOPEZ

Provider Business Mailing Address
First Line	:	PO BOX 1289
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33601-1289
Country	:	US
Telephone Number	:	813-844-7500
Fax Number	:	813-844-1141

Provider Business Practice Location Address
First Line	:	6488 N US HIGHWAY 41
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-1804
Country	:	US
Telephone Number	:	813-844-7500
Fax Number	:	813-844-1141

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

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	06/08/2021

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