Individual
DR. XAVIER LOPEZ GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2100 W IOWA AVE, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2365
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
11223
OK
208000000X
Pediatrics Physician
76-179
NM
208000000X
Pediatrics Physician
Primary
A38332
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200023140A
—
OK
Enumeration date
06/30/2006
Last updated
07/25/2019
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