Provider Demographics
NPI:1881919124
Name:LOPEZ, EMILIO ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:EMILIO
Middle Name:ENRIQUE
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 1:7556 LAKE WORTH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2503
Mailing Address - Country:US
Mailing Address - Phone:561-894-1370
Mailing Address - Fax:
Practice Address - Street 1:7556 LAKE WORTH RD STE 103
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2503
Practice Address - Country:US
Practice Address - Phone:561-894-1370
Practice Address - Fax:561-894-1372
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1291182085R0204X
TN548032085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104439200Medicaid