Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 036104977 | IL |
Y | 207W00000X | Ophthalmologist | ME80092 | FL |
NPI | 1013941657 |
---|---|
Provider Name | Dr. Fernando Lopez |
First Address | Miami, FL 33134-2616 |
Second Address | Miami, FL 33134-2639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 31/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H13548 | (02) | IL |