Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | MD 60476381 | WA |
N | 2084N0600X | Clinical Neurophysiologist | MD 60476381 | WA |
NPI | 1316144728 |
---|---|
Provider Name | Dr. Jonathan Peter Lopez |
First Address | Seattle, WA 98105-3901 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 04/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1622251 | (05) | AK |
G8933624 | MEDICARE (01) | |
G89336323 | MEDICARE (01) |