Individual
DR. AMANTE AGUSTIN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
327 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9006
(681) 342-1610
(681) 342-1626
Mailing address
327 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9006
(681) 342-1000
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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