Provider Demographics
NPI:1306332812
Name:LOPEZ, PAUL DAVID (MD, SA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16756 ABBEY HILL CT
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6353
Mailing Address - Country:US
Mailing Address - Phone:407-480-0295
Mailing Address - Fax:
Practice Address - Street 1:16756 ABBEY HILL CT
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6353
Practice Address - Country:US
Practice Address - Phone:407-480-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant