Individual
RUBEN J LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1728 DUNLAWTON AVE, SUITE 1, PORT ORANGE, FL 32127-8929
(386) 322-5390
(386) 322-5391
Mailing address
1728 DUNLAWTON AVE, SUITE 1, PORT ORANGE, FL 32127-8929
(386) 322-5390
(386) 322-5391
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
68668
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250201100
—
FL
01
—
31712
BCBS
FL
01
—
ME0068668
DCWO
FL
01
—
ME68668
VHN
FL
Enumeration date
03/22/2006
Last updated
01/26/2022
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