Provider Demographics
NPI:1669458618
Name:LOPEZ, REYNOLD E (MD)
Entity Type:Individual
Prefix:DR
First Name:REYNOLD
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:431 PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 328
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3418
Mailing Address - Country:US
Mailing Address - Phone:787-281-3838
Mailing Address - Fax:787-281-0124
Practice Address - Street 1:431 PONCE DE LEON AVE
Practice Address - Street 2:SUITE 328
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3418
Practice Address - Country:US
Practice Address - Phone:787-281-3838
Practice Address - Fax:787-281-0124
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR40332086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREO4087Medicare UPIN