Provider Demographics
NPI:1841433687
Name:LOPEZ, LUIS ERIC
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ERIC
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-7500
Mailing Address - Fax:813-844-1141
Practice Address - Street 1:6488 N US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-1804
Practice Address - Country:US
Practice Address - Phone:813-844-7500
Practice Address - Fax:813-844-1141
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016663700Medicaid
FL016663700Medicaid