Individual
JOSE R LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
910 WORTH STREET, FOOTHILLS PRIMARY CARE, MOUNT AIRY, NC 27030
(336) 716-2255
(336) 783-6842
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2255
(336) 783-6842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2012-00004
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5919100
—
NC
Enumeration date
08/09/2005
Last updated
03/15/2012
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