Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | BP10046337 | TX |
N | 208600000X | Surgeon | BP10046337 | TX |
Y | 2086S0120X | Pediatric Surgery | 2020013076 | MO |
NPI | 1558797464 |
---|---|
Provider Name | Omar Nunez Lopez |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2013 |
Last Update Date | 04/08/2020 |