Individual
DR. AMANTE AGUSTIN LOPEZ
Active
Individual
DR. AMANTE AGUSTIN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
16170
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720948
MOUNTAIN STATE BCBS
WV
05
—
0059024000
—
WV
01
—
229645
CARELINK
—
01
—
WV16170
HEALTH PLAN
—
Enumeration date
07/17/2006
Last updated
01/17/2018
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