Provider Demographics
NPI:1316144728
Name:LOPEZ, JONATHAN PETER (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PETER
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 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:NEUROLOGY, MB.7.420
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-2078
Mailing Address - Fax:206-987-2649
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:NEUROLOGY, MB.7.420
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2078
Practice Address - Fax:206-987-2649
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 604763812084N0402X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8933624OtherMEDICARE
G89336323OtherMEDICARE
AK1622251Medicaid