Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25237 | CO |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | DR.0025237 | CO |
NPI | 1740484427 |
---|---|
Provider Name | Joseph Martin Lopez |
First Address | Fort Collins, CO 80524-3929 |
Second Address | Fort Collins, CO 80524-3929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 22/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01252378 | (05) | CO |
D24593 | (02) | CO |