Provider Demographics
NPI:1003956624
Name:LOPEZ MEJIA, GERARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:LOPEZ MEJIA
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 1:14321 NE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8624
Mailing Address - Country:US
Mailing Address - Phone:405-342-0255
Mailing Address - Fax:405-610-6960
Practice Address - Street 1:14321 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8624
Practice Address - Country:US
Practice Address - Phone:405-342-0255
Practice Address - Fax:405-610-6960
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine