Organization
G MICHAEL LOPEZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. G MICHAEL LOPEZ MD (OWNER)
(505) 425-9311
Entity
Organization
Contact information
Practice address
105 MILLS AVE STE 300, LAS VEGAS, NM 87701-4169
(505) 425-9311
(505) 425-9047
Mailing address
105 MILLS AVE # 300, LAS VEGAS, NM 87701
(505) 425-9311
(505) 425-9047
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
NM81-770
NM
363A00000X
Physician Assistant
92PA09
NM
363LA2200X
Adult Health Nurse Practitioner
R53421
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00007070
—
NM
01
—
201006000
PRESBYTERIAN HEALTH PLAN
NM
01
—
NM001568
BLUE CROSS BLUE SHIELD
NM
01
—
NM001568
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/23/2009
Last updated
07/23/2009
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