Provider Demographics
NPI:1548376502
Name:LOPEZ, CARLOS M (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name: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 1:8011 N HIMES AVE
Mailing Address - Street 2:1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614
Mailing Address - Country:US
Mailing Address - Phone:813-935-3000
Mailing Address - Fax:813-935-4017
Practice Address - Street 1:8011 N HIMES AVE
Practice Address - Street 2:1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-935-3000
Practice Address - Fax:813-935-4017
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033378207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E34633Medicare UPIN
FL30507Medicare ID - Type Unspecified