Individual
GERARDO C LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
527 MEDICAL PARK DR STE 304, BRIDGEPORT, WV 26330
(304) 933-3830
(304) 933-3837
Mailing address
527 MEDICAL PARK DR STE 304, BRIDGEPORT, WV 26330-9010
(304) 933-3830
(304) 933-3837
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
17559
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720850
BLUE CROSS BLUE SHEILD
WV
05
—
0081763000
—
WV
01
—
WV17559A
HEALTH PLAN
WV
Enumeration date
05/16/2006
Last updated
07/21/2022
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