Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 241-007 | MA |
N | 208600000X | Surgeon | 241-007 | MA |
Y | 2086S0102X | Surgical Critical Care | 076310 | GA |
NPI | 1003046525 |
---|---|
Provider Name | Dr. Enrique Patrick Lopez |
First Address | Albany, GA 31701-1900 |
Second Address | Albany, GA 31701-1943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2009 |
Last Update Date | 17/03/2018 |