Individual
SEBASTIAN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 W COUNTRY CLUB RD, SUITE 201, ROSWELL, NM 88201-5224
(575) 627-0535
Mailing address
405 W COUNTRY CLUB RD, C/O MSO ADMINISTRATION, ROSWELL, NM 88201-5209
(575) 624-4777
(575) 624-8711
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
27867
AZ
208600000X
Surgery Physician
Primary
MD2008-0699
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020043666
RR MEDICARE
AZ
01
—
2214988
AETNA
AZ
01
—
2Z0574
HEALTHNET
AZ
05
—
36128384
—
NM
05
—
479875
—
AZ
01
—
AZ0850750
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
06/28/2005
Last updated
12/07/2020
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