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Individual
JORGE L LOPEZ
Active
Individual
JORGE L LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005841
GA
363A00000X
Physician Assistant
PA 9101712
FL
Other
Enumeration date
05/01/2007
Last updated
09/21/2016
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