Provider Demographics
NPI:1871032466
Name:LOPEZ PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:LOPEZ PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-707-5498
Mailing Address - Street 1:4863 PALM COAST PKWY NW UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3665
Mailing Address - Country:US
Mailing Address - Phone:910-332-5303
Mailing Address - Fax:904-212-1351
Practice Address - Street 1:4863 PALM COAST PKWY NW UNIT 2&3
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3666
Practice Address - Country:US
Practice Address - Phone:386-222-7746
Practice Address - Fax:904-212-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1071532081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty