Provider Demographics
NPI:1477504066
Name:LOPEZ, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:750 WELLINGTON AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6132
Mailing Address - Country:US
Mailing Address - Phone:970-248-3188
Mailing Address - Fax:970-248-3190
Practice Address - Street 1:2310 PEGER RD STE 104
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5305
Practice Address - Country:US
Practice Address - Phone:907-456-3876
Practice Address - Fax:907-456-3877
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-01-11
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Provider Licenses
StateLicense IDTaxonomies
AK6080207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74239520Medicaid
COC809392Medicare PIN