Provider Demographics
NPI:1801145032
Name:LOPEZ, LIURKA V (MD)
Entity type:Individual
Prefix:MISS
First Name:LIURKA
Middle Name:V
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LIURKA
Other - Middle Name:VONN-DALID
Other - Last Name:LOPEZ-MATIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1501 KINGS HIGHWAY
Mailing Address - Street 2:ATTN: LEISA OGLESBY (RM. 1-201)
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-4881
Mailing Address - Fax:318-675-5069
Practice Address - Street 1:301 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5167
Practice Address - Country:US
Practice Address - Phone:386-231-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.34761174400000X
LA307775207ZC0006X
FLME139652207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Single Specialty