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Individual

JUAN CARLOS LOPEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
175 S WILKES BARRE BLVD, WILKES BARRE, PA 18702-5040
(570) 829-2621
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD471708
PA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/20/2016
Last updated
02/22/2021
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