Provider Demographics
NPI:1730130857
Name:LOPEZ, ALBERT ARTHUR JR (DO)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ARTHUR
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:4291 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2061
Practice Address - Country:US
Practice Address - Phone:904-598-1888
Practice Address - Fax:904-384-4928
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57573BOtherMEDICARE LEGACY NUMBER
FLG09027Medicare UPIN
FLK4319Medicare PIN
GA110243459Medicare PIN