Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 16998 | OK |
NPI | 1013905942 |
---|---|
Provider Name | Dr. Martin J Lopez |
First Address | Oklahoma City, OK 73199-0001 |
Second Address | Oklahoma City, OK 73109-3845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 07/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050032793 | RAILROAD MEDICARE (01) | OK |
100096400A | (05) | OK |
4460958 | AETNA (01) | OK |
F27138 | (02) | OK |