Provider Demographics
NPI:1295729986
Name:LOPEZ DE ARCO, JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:LOPEZ DE ARCO
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 1:3074 DYER BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7839
Mailing Address - Country:US
Mailing Address - Phone:407-635-3011
Mailing Address - Fax:321-203-4627
Practice Address - Street 1:3074 DYER BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-635-3011
Practice Address - Fax:321-203-4627
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95848207RE0101X
FLME 95848207R00000X
CAA76864207R00000X
PR14082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH57131Medicare UPIN
PR21541Medicare ID - Type Unspecified