Provider Demographics
NPI:1518041029
Name:LOPEZ, FABIAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:FABIAN
Middle Name:A
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 1:1345 LINCOLN RD APT 1205
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2271
Mailing Address - Country:US
Mailing Address - Phone:305-623-6310
Mailing Address - Fax:
Practice Address - Street 1:1345 LINCOLN RD APT 1205
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2271
Practice Address - Country:US
Practice Address - Phone:305-623-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP300207R00000X
OR190080207R00000X
NC201702633207R00000X
CA55182207R00000X
KY51156208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3766XMedicare UPIN