Individual
JOSE LOPEZ MALDONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2604 MEDICAL OFFICE PL, GOLDSBORO, NC 27534-9417
(919) 580-0004
(919) 580-9224
Mailing address
2604 MEDICAL OFFICE PL, GOLDSBORO, NC 27534-9417
(919) 580-0004
(919) 580-9224
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102234
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102234
LICENSE
NC
Enumeration date
10/13/2006
Last updated
02/04/2014
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