| Lopez Internal Medicine Associates Inc. | |
|
4291 Roosevelt Blvd Suite Jacksonville FL 32210-2061 | |
| (904) 598-1888 | |
| (904) 384-4928 |
| Full Name | Lopez Internal Medicine Associates Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4291 Roosevelt Blvd, Jacksonville, Florida |
| Authorized Official Name and Position | Albert Arthur Lopez (CEO) |
| Authorized Official Contact | 9045981888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lopez Internal Medicine Associates Inc. 4291 Roosevelt Blvd Suite 204 Jacksonville FL 32210-2061 Ph: (904) 598-1888 | Lopez Internal Medicine Associates Inc. 4291 Roosevelt Blvd Suite Jacksonville FL 32210-2061 Ph: (904) 598-1888 |
| NPI Number | 1730374612 |
|---|---|
| Provider Enumeration Date | 09/13/2007 |
| Last Update Date | 12/21/2016 |
| Medicare PECOS PAC ID | 5890969547 |
|---|---|
| Medicare Enrollment ID | O20111116000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730374612 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | OS0007397 (Florida) | Primary |
| Provider Name | Albert A Lopez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730130857 PECOS PAC ID: 3678747334 Enrollment ID: I20111116000167 |
| Provider Name | Ricky Mccoy Kirby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528010055 PECOS PAC ID: 4789842709 Enrollment ID: I20120222000672 |
| Provider Name | Lauren J Gorter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598207805 PECOS PAC ID: 8921340365 Enrollment ID: I20190503001756 |
| Provider Name | Sona P Dolsenhe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104434901 PECOS PAC ID: 1456767342 Enrollment ID: I20210301000922 |
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