Provider Demographics
NPI:1942603667
Name:JOSE IGNACIO LOPEZ, MD., PA
Entity Type:Organization
Organization Name:JOSE IGNACIO LOPEZ, MD., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-890-8000
Mailing Address - Street 1:6101 WEBB RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2872
Mailing Address - Country:US
Mailing Address - Phone:813-890-8000
Mailing Address - Fax:813-886-0508
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:SUITE 209
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-890-8000
Practice Address - Fax:813-886-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269738600Medicaid
FL269738600Medicaid
FLH56175Medicare UPIN