Provider Demographics
NPI:1609842517
Name:LOPRESTI, DAVID CALLAWAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CALLAWAY
Last Name:LOPRESTI
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:PO BOX 64568
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-4568
Mailing Address - Country:US
Mailing Address - Phone:480-374-7354
Mailing Address - Fax:
Practice Address - Street 1:4001 E BASELINE RD STE 107
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-374-7354
Practice Address - Fax:480-371-1121
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ432332085R0204X
CO520862085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO296390YLQ8Medicare PIN