Individual
IVAN D. LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4300 SW 13TH ST, GAINESVILLE, FL 32608-4006
(352) 374-5600
Mailing address
439 SW MICHIGAN ST, LAKE CITY, FL 32025-0440
(386) 487-0800
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
24227
WV
2084P0800X
Psychiatry Physician
Primary
ME108228
FL
2084P0804X
Child & Adolescent Psychiatry Physician
24227
WV
Other
Enumeration date
10/07/2005
Last updated
07/29/2015
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