Provider Demographics
NPI:1003973397
Name:LOPEZ, G. MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:G. MICHAEL
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 1:105 MILLS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4169
Mailing Address - Country:US
Mailing Address - Phone:505-425-9311
Mailing Address - Fax:505-425-9047
Practice Address - Street 1:105 MILLS AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4169
Practice Address - Country:US
Practice Address - Phone:505-425-9311
Practice Address - Fax:505-425-9047
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01651363LP2300X
NMNM81-77207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001568OtherBLUE CROSS BLUE SHIELD
NMNM00007070Medicaid
NM1991OtherLOVELACE
NM50013OtherHMO OF NEW MEXICO
NM201006000OtherPRESBYTERIAN HEALTH PLAN
NM201006000OtherPRESBYTERIAN HEALTH PLAN
NMNM001568OtherBLUE CROSS BLUE SHIELD