Individual
JOSEPH JULIAN LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
159 N 3RD ST, MACCLENNY, FL 32063-2103
(904) 259-3151
Mailing address
159 N 3RD ST, MACCLENNY, FL 32063-2103
(904) 259-3151
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
01068725A
IN
207RG0100X
Gastroenterology Physician
036.126463
IL
207RG0100X
Gastroenterology Physician
4301097716
MI
207RG0100X
Gastroenterology Physician
6073
NV
207RG0100X
Gastroenterology Physician
Primary
ME 123793
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002019037
—
NV
05
—
015372200
—
FL
01
—
100010704
RR MEDICARE
NV
01
—
KK9HW
BCBS
FL
01
—
NV0397
BCBS ID
NV
01
—
P01552787
RR MEDICARE
FL
Enumeration date
05/04/2006
Last updated
08/08/2016
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