Provider Demographics
NPI:1942263702
Name:LOPEZ, MELVIN MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:MANUEL
Last Name:LOPEZ
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 1:12555 WOODVIEW COURT
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7309
Mailing Address - Country:US
Mailing Address - Phone:816-431-9060
Mailing Address - Fax:
Practice Address - Street 1:12555 WOODVIEW CT
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7309
Practice Address - Country:US
Practice Address - Phone:816-431-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001009691207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0593343Medicaid
IA0593343Medicaid
MO762E087Medicare ID - Type UnspecifiedPROVIDER NUMBER