Provider Demographics
NPI:1902006315
Name:JC LOPEZ ESCOBAR MD PA
Entity Type:Organization
Organization Name:JC LOPEZ ESCOBAR MD PA
Other - Org Name:JOSE C. LOPEZ, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-752-2270
Mailing Address - Street 1:13168 SW 188TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3002
Mailing Address - Country:US
Mailing Address - Phone:786-581-9116
Mailing Address - Fax:786-592-2352
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:786-581-9116
Practice Address - Fax:786-592-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE22633Medicare UPIN
FL08846XMedicare PIN