Individual
MARIO J LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1620 TAMIAMI TRAIL, SUITE 308, PORT CHARLOTTE, FL 33948-4017
(941) 246-2482
(941) 979-9074
Mailing address
1620 TAMIAMI TRAIL, SUITE 308, PORT CHARLOTTE, FL 33948-4017
(941) 246-2482
(941) 979-9074
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MEOO50048
FL
207RC0000X
Cardiovascular Disease Physician
Primary
ME50048
FL
2085R0202X
Diagnostic Radiology Physician
ME50048
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046520800
—
FL
Enumeration date
08/13/2006
Last updated
10/31/2025
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