Individual
J. ANTONIO G LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6140 W CURTISIAN AVE, SUITE 200, BOISE, ID 83704-0107
(208) 367-4278
(208) 367-5200
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
G56032
CA
207RC0000X
Cardiovascular Disease Physician
Primary
M-9898
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G560320
—
CA
01
—
P00208355
RAILROAD MEDICARE
CA
Enumeration date
02/09/2006
Last updated
08/11/2014
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