Provider Demographics
NPI:1023015807
Name:LOPEZ, WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:LOPEZ
Suffix:JR
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 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:NORTH MEDICAL OFFICE BUILDING
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-203-7050
Mailing Address - Fax:970-203-7055
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:NORTH MEDICAL OFFICE BUILDING
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-203-7050
Practice Address - Fax:970-203-7055
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-03-23
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CO20787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01207877Medicaid
COP00931157OtherMEDICARE RAILROAD CARRIER PTAN
COCOA102142Medicare PIN
COP00931157OtherMEDICARE RAILROAD CARRIER PTAN
COD23831Medicare UPIN
COCO305402Medicare PIN
COCO304672Medicare PIN