Provider Demographics
NPI:1740421551
Name:LOPEZ-CORONA, ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:LOPEZ-CORONA
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 1:2214 CANTERBURY DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2386
Mailing Address - Country:US
Mailing Address - Phone:785-628-6014
Mailing Address - Fax:785-628-6094
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:SUITE 308
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2386
Practice Address - Country:US
Practice Address - Phone:785-628-6014
Practice Address - Fax:785-628-6094
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33874208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology