Provider Demographics
NPI:1548385388
Name:LOPEZ-SAMOYA, OMAR E (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:E
Last Name:LOPEZ-SAMOYA
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 1:2323 LIME KILN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3416
Mailing Address - Country:US
Mailing Address - Phone:502-339-8000
Mailing Address - Fax:502-339-8501
Practice Address - Street 1:2323 LIME KILN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3416
Practice Address - Country:US
Practice Address - Phone:502-339-8000
Practice Address - Fax:502-339-8501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23139207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E05465Medicare UPIN