Individual
GLORIA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
3500 TOWER AVE, SUPERIOR, WI 54880-5335
(715) 395-5454
Mailing address
3500 TOWER AVE, SUPERIOR, WI 54880-5335
(715) 395-5454
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50939-020
WI
Other
Enumeration date
09/14/2006
Last updated
11/07/2007
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