Provider Demographics
NPI:1417938689
Name:LOPERA, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LOPERA
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 1:1501 CORPORATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6654
Mailing Address - Country:US
Mailing Address - Phone:561-369-4255
Mailing Address - Fax:954-838-9660
Practice Address - Street 1:3255 FOREST HILL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-5854
Practice Address - Country:US
Practice Address - Phone:561-964-4577
Practice Address - Fax:561-369-3254
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91277207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00307191OtherRR MCR
FL271749200Medicaid
FL50338OtherBCBS
FL271749200Medicaid
FL50338XMedicare PIN
FL50338YMedicare PIN
FL50338AMedicare PIN