Provider Demographics
NPI:1760011845
Name:LOPEZ, DANIEL JOSE (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSE
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 1:3913 AMERICANA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7405
Mailing Address - Country:US
Mailing Address - Phone:352-600-6780
Mailing Address - Fax:352-600-6765
Practice Address - Street 1:5367 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4540
Practice Address - Country:US
Practice Address - Phone:352-600-6780
Practice Address - Fax:352-600-6765
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME158773207P00000X, 208VP0000X, 208VP0014X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program