Provider Demographics
NPI:1417033994
Name:LOPEZ, ISMAEL PADILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:PADILLA
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 1:4351 E LOHMAN AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8263
Mailing Address - Country:US
Mailing Address - Phone:575-532-7161
Mailing Address - Fax:575-522-3743
Practice Address - Street 1:4351 E LOHMAN AVE STE 408
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8263
Practice Address - Country:US
Practice Address - Phone:575-532-7161
Practice Address - Fax:575-522-3743
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92-165207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM7300534OtherAETNA
NM202018555OtherPRESBYTERIAN
NME4953Medicaid
NM600521042OtherGROUP PTAN
NMNM002M09OtherBLUECROSS BLUESHIELD
NMNM002M09OtherBLUECROSS BLUESHIELD
NME4953Medicaid