Provider Demographics
NPI:1548290703
Name:CARLOS LOPEZ M.D P.A
Entity type:Organization
Organization Name:CARLOS LOPEZ M.D P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-861-5765
Mailing Address - Street 1:1133 SE 18TH PL
Mailing Address - Street 2:SUITE #2
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5410
Mailing Address - Country:US
Mailing Address - Phone:352-861-5765
Mailing Address - Fax:352-867-1801
Practice Address - Street 1:1133 SE 18TH PL
Practice Address - Street 2:SUITE #2
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5410
Practice Address - Country:US
Practice Address - Phone:352-861-5765
Practice Address - Fax:352-867-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55323207R00000X
FL416402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty