Provider Demographics
NPI:1043545833
Name:MORENO LOPEZ, JOSE ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE ANDRES
Middle Name:
Last Name:MORENO 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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-688-7880
Mailing Address - Fax:319-688-7881
Practice Address - Street 1:540 E JEFFERSON ST STE 205
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2479
Practice Address - Country:US
Practice Address - Phone:319-688-7880
Practice Address - Fax:319-688-7881
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-494812086S0127X, 208600000X
FLTRN15501208600000X
WI60049-202086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043545833Medicaid