Provider Demographics
NPI:1538341789
Name:LUIS J LOPEZ MD PA
Entity type:Organization
Organization Name:LUIS J LOPEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-792-9752
Mailing Address - Street 1:4700 N HABANA AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7122
Mailing Address - Country:US
Mailing Address - Phone:813-324-5888
Mailing Address - Fax:813-374-8891
Practice Address - Street 1:4700 N. HABANA AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7122
Practice Address - Country:US
Practice Address - Phone:813-324-5888
Practice Address - Fax:813-374-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275993400Medicaid
FLME93505OtherMEDICAL LICENSE
FLI42984Medicare UPIN
FLME93505OtherMEDICAL LICENSE
FLAK886Medicare PIN