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Individual

JOHN D. LOPEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
4901 GRANDE DR, PENSACOLA, FL 32504-8965
(850) 477-7042
(850) 474-9060
Mailing address
4901 GRANDE DR, PENSACOLA, FL 32504-8965
(850) 477-7042
(850) 474-9060

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
109696
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP1726152
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009953310
AL
05
303630800
FL
01
430064443
RAILROAD MEDICARE
FL
01
59084591
BLUE CROSS & BLUE SHIELD
AL
01
G1244
BLUECROSS & BLUESHIELD
FL
Enumeration date
08/15/2005
Last updated
10/13/2016
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