Provider Demographics
NPI:1730174319
Name:LOPEZ, FERNANDO (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
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 1:1445 BROOKS LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8624
Mailing Address - Country:US
Mailing Address - Phone:407-207-6768
Mailing Address - Fax:407-249-5025
Practice Address - Street 1:11399 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5023
Practice Address - Country:US
Practice Address - Phone:407-207-6768
Practice Address - Fax:407-249-5025
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45835207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0700182OtherUHC
FL041499900Medicaid
FL0702702OtherUHC-MCAID
FL115985OtherAMERIGROUP
FL0352240004OtherCIGNA PPO
FLE21467OtherFHHS
FLP2921904OtherOXFORD HEALTH
FL0352240013OtherCIGNA HMO
FL4603519OtherAETNA PPO
FL08164OtherBCBS
FL2841691OtherAETNA HMO
FL103674OtherAVMED
FL08164OtherBCBS
FL08164AMedicare ID - Type Unspecified