Provider Demographics
NPI:1114041126
Name:LOPEZ, ALBERTO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:JOSE
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 1:4447 SOMERSET PATH
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4419
Mailing Address - Country:US
Mailing Address - Phone:216-965-7384
Mailing Address - Fax:
Practice Address - Street 1:4447 SOMERSET PATH
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-4419
Practice Address - Country:US
Practice Address - Phone:216-965-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603988382086S0129X
FLME1155992086S0129X
OH35.0913442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery