MEDICARE: JOSEPH JULIAN LOPEZ MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	6073	NV
2	207RG0100X	Gastroenterology Physician	4301097716	MI
3	207RG0100X	Gastroenterology Physician	01068725A	IN
4	207RG0100X	Gastroenterology Physician	036.126463	IL
5	207RG0100X	Gastroenterology Physician	ME 123793	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	100010704	OTHER	NV	RR MEDICARE
6	P01552787	OTHER	FL	RR MEDICARE

#	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
4	NV0397	OTHER	NV	BCBS ID
5	KK9HW	OTHER	FL	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1992753016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH JULIAN LOPEZ MD

Provider Business Mailing Address
First Line	:	159 N 3RD ST
Second Line	:
City	:	MACCLENNY
State	:	FL
Zip	:	32063-2103
Country	:	US
Telephone Number	:	904-259-3151
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 N 3RD ST
Second Line	:
City	:	MACCLENNY
State	:	FL
Zip	:	32063-2103
Country	:	US
Telephone Number	:	904-259-3151
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/08/2016

155 N 3RD ST
MACCLENNY, FL
32063-2103

Practice Phone: 904-653-4700
Practice Fax: