Provider Demographics
NPI:1609899525
Name:LOPEZ, ALFREDO A (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
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 1:1542 TULANE AVE
Mailing Address - Street 2:BOX T4M-2
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112
Mailing Address - Country:US
Mailing Address - Phone:504-568-5722
Mailing Address - Fax:504-568-2127
Practice Address - Street 1:136 S. ROMAN STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-903-6572
Practice Address - Fax:504-903-6842
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.12704R207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1542067Medicaid
5A722Medicare ID - Type Unspecified
LA1542067Medicaid