Individual
MAX RAUL LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5602
Mailing address
2500 NORTH STATE STREET, JMM ROOM 2525, JACKSON, MS 39216-4500
(601) 815-2869
(601) 815-9356
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
23895
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05339035
—
MS
Enumeration date
03/27/2012
Last updated
12/29/2015
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