Provider Demographics
NPI:1447288972
Name:JORDAN-LOPEZ, TOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:
Last Name:JORDAN-LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51-39 AVE MAIN
Mailing Address - Street 2:SANTA ROSA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6653
Mailing Address - Country:US
Mailing Address - Phone:787-798-5615
Mailing Address - Fax:787-740-1445
Practice Address - Street 1:51-39 AVE MAIN
Practice Address - Street 2:SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6653
Practice Address - Country:US
Practice Address - Phone:787-798-5615
Practice Address - Fax:787-740-1445
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5701208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D08443Medicare UPIN
0027960Medicare ID - Type Unspecified