Provider Demographics
NPI:1669404893
Name:LOPEZ, CARLOS MANUEL (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
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 1:1133 SE 18TH PL
Mailing Address - Street 2:SUITE #2
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5410
Mailing Address - Country:US
Mailing Address - Phone:352-861-5765
Mailing Address - Fax:352-867-1801
Practice Address - Street 1:1133 SE 18TH PL
Practice Address - Street 2:SUITE #2
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5410
Practice Address - Country:US
Practice Address - Phone:352-861-5765
Practice Address - Fax:352-867-1801
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10357AMedicare ID - Type Unspecified
FLE57405Medicare UPIN