Provider Demographics
NPI:1437340213
Name:LOPEZ, GREGORY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
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 1:202 N DIVISION ST
Mailing Address - Street 2:PLAZA ONE, MS: 202-E1-ER
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-4939
Mailing Address - Country:US
Mailing Address - Phone:253-545-2564
Mailing Address - Fax:253-333-2547
Practice Address - Street 1:202 N DIVISION ST
Practice Address - Street 2:PLAZA ONE, MS: 202-E1-ER
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-545-2564
Practice Address - Fax:253-333-2547
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120993207P00000X
WAMD60316535207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine