Provider Demographics
NPI:1104910181
Name:JOSEPH M LOPEZ MD PC
Entity type:Organization
Organization Name:JOSEPH M LOPEZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-221-5925
Mailing Address - Street 1:1136 E STUART ST
Mailing Address - Street 2:SUITE 4202
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-221-5925
Mailing Address - Fax:970-221-5012
Practice Address - Street 1:1136 E STUART ST
Practice Address - Street 2:SUITE 4202
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-221-5925
Practice Address - Fax:970-221-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR32757550001OtherCIGNA HEALTHCARE
55181OtherFEDERA BC BS
0004586257OtherAETNA
000585011OtherAPWU HEALTH PLAN
CO01252378Medicaid
C09900002163OtherSIERRA HEALTH & LIFE
CO010011909OtherRAILROAD MEDICARE
120085BFOtherPREFERRED ADMINISTRATIVE
33143OtherANTHEM BC BS
0135688OtherMAIL HANDLERS BENEFIT PLA
=========805250000OtherWPS TRICARE ADMINISTRATIO
PR32757550001OtherCIGNA HEALTHCARE
0135688OtherMAIL HANDLERS BENEFIT PLA
0004586257OtherAETNA
CO01252378Medicaid