Individual
BLAKE FAIRCHILD LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1802 6TH AVE S, BIRMINGHAM, AL 35233-1932
(256) 328-9934
Mailing address
4781 LONGMEADOW DR, BESSEMER, AL 35022-7015
(256) 328-9934
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2093
AL
Other
Enumeration date
01/04/2023
Last updated
11/19/2024
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