Individual
FERNANDO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
134 PREVATT RD, DOTHAN, AL 36301-5427
(334) 794-0731
(334) 671-9199
Mailing address
PO BOX 1245, DOTHAN, AL 36302-1245
(334) 712-2720
(334) 712-2727
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
6436
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009934129
—
AL
05
—
009937156
—
AL
05
—
009979055
—
AL
05
—
009979915
—
AL
01
—
051000544
OSC - BCBS
AL
01
—
051000547
SPS - BCBS
AL
01
—
051533769
EBHS - BCBS
AL
01
—
051533770
TROY - BCBS
AL
Enumeration date
07/20/2006
Last updated
04/04/2013
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