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Individual

DR. ENRICO LOPEZ MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5880 UNIVERSITY AVE STE 102, WEST DES MOINES, IA 50266-8209
(515) 633-3600
(515) 288-0840
Mailing address
PO BOX 9170, DES MOINES, IA 50306-9170
(515) 633-3600
(515) 633-3838

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
37512
IA
207UN0901X
Nuclear Cardiology Physician
37512
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036107290 1
IL
01
101 15504
B/C B/S OF ILLINOIS
IL
05
1942229562
IA
01
71046
BC/BS OF IOWA
IA
01
CB0709/060070355
RR MEDICARE GROUP #/PIN
GA
Enumeration date
07/18/2006
Last updated
06/14/2020
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