Individual
MARK D. LOPEZ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1003 WILLOW CREEK RD, PRESCOTT, AZ 86301-1641
(928) 445-2700
Mailing address
2965 W CRESTVIEW DR, PRESCOTT, AZ 86305-7014
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
29284
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
596489
—
AZ
Enumeration date
04/19/2006
Last updated
07/08/2007
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