Provider Demographics
NPI:1194816140
Name:LOPEZ, EDWARD JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9247
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9247
Mailing Address - Country:US
Mailing Address - Phone:706-322-7884
Mailing Address - Fax:706-243-4345
Practice Address - Street 1:705 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3500
Practice Address - Country:US
Practice Address - Phone:706-322-7884
Practice Address - Fax:706-243-4355
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL246213E00000X
TX1541213E00000X
CAE-3603213E00000X
GA000814213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000750439OMedicaid
GA814OtherSTATE ID
GA202I501203OtherMEDICARE PTAN
GAU12647Medicare UPIN