Provider Demographics
NPI:1396364659
Name:LOPER, ANTONIO JOEL LAURENCE (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:JOEL LAURENCE
Last Name:LOPER
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 1:1714 S QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-7009
Mailing Address - Country:US
Mailing Address - Phone:918-991-8669
Mailing Address - Fax:
Practice Address - Street 1:1714 S QUINCY AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-7009
Practice Address - Country:US
Practice Address - Phone:918-991-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7609212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry