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Individual

JORGE IVAN LOPEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1600 MEDICAL CENTER DR STE B500, HUNTINGTON, WV 25701-3655
(304) 691-1787
Mailing address
1600 MEDICAL CENTER DR STE B500, HUNTINGTON, WV 25701-3655
(304) 691-1787
(304) 691-8711

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
17440
AL
2084N0400X
Neurology Physician
28628
WV
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
17440
AL
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
28628
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
051113410
BCBS
AL
01
051596435
BCBS
AL
01
051596437
BCBS
AL
01
051596439
BCBS
AL
05
107325
AL
05
107326
AL
05
107327
AL
05
125428
AL
01
P00720170
RAILROAD MEDICARE
AL
Enumeration date
05/05/2006
Last updated
11/24/2021
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