Individual
MIGUEL LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
338082
LA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
338082
LA
Other
Enumeration date
04/17/2017
Last updated
10/24/2023
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