Provider Demographics
NPI:1023130614
Name:LOPEZ, JESSE JOSEPH JR (DO)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:JOSEPH
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-0390
Mailing Address - Country:US
Mailing Address - Phone:913-647-3999
Mailing Address - Fax:913-754-1046
Practice Address - Street 1:7201 W 110TH ST STE 120
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2365
Practice Address - Country:US
Practice Address - Phone:913-647-3999
Practice Address - Fax:913-754-1046
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2022-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0522861208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF65651Medicare UPIN
KS000A189Medicare ID - Type Unspecified