Provider Demographics
NPI:1699021337
Name:LOPEZ, ALEJANDRO EMILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:EMILIO
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 1:1514 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-6101
Mailing Address - Country:US
Mailing Address - Phone:602-283-5732
Mailing Address - Fax:602-314-4579
Practice Address - Street 1:1514 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-6101
Practice Address - Country:US
Practice Address - Phone:602-283-5732
Practice Address - Fax:602-314-4579
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ48376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ870709Medicaid
AZ870709Medicaid