Individual
DR. RAFAEL LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2180 W 1ST ST, SUITE 202, FORT MYERS, FL 33901-3222
(239) 332-8009
(239) 332-4977
Mailing address
12424 BRANTLEY COMMONS CT, FORT MYERS, FL 33907-5680
(239) 332-8009
(239) 332-4977
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
ME69037
FL
2084P0800X
Psychiatry Physician
Primary
ME69037
FL
2084P0800X
Psychiatry Physician
ME69037
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251555500
—
FL
Enumeration date
02/07/2007
Last updated
01/02/2018
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