Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME130127 | FL |
Y | 207QA0505X | Family Doctor - Adult Medicine | ME130127 | FL |
N | 207V00000X | Obstetrician & Gynecologist | 18239 | AL |
N | 207V00000X | Obstetrician & Gynecologist | ME130127 | FL |
NPI | 1083708747 |
---|---|
Provider Name | Dr. Raymond A Lopez |
First Address | Madison, AL 35758-2372 |
Second Address | Madison, AL 35758-2372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 22/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51097396 | BLUE CROSS&BLUE SHIELD (01) | AL |
A64536 | (02) | AL |