Provider Demographics
NPI:1922166974
Name:LOPEZ, DEBORAH MARIA (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 SPANISH OAKS LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119
Mailing Address - Country:US
Mailing Address - Phone:239-593-5410
Mailing Address - Fax:
Practice Address - Street 1:11190 HEALTH PARK BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110
Practice Address - Country:US
Practice Address - Phone:239-552-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1987632080P0203X
FLME 976752080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97675OtherMEDICAL LICENSE
NY01745399Medicaid
NYF99364Medicare UPIN
NY113602Medicare ID - Type Unspecified