Miqueas Lopez
Physician Assistant in St Petersburg, FL. Individual provider (NPI-1).
NPI number1124729348
StatusActive
Last updated in NPPESJun 7, 2023
Details
- NPI
- 1124729348
- Entity type
- Individual (NPI-1)
- Name
- Miqueas Lopez
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 14, 2023
- Certification date
- Jun 7, 2023
- Last updated
- Jun 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA9117182 | FL | Yes |
Practice location
1200 7th Ave NSt Petersburg, FL 33705-1300
Phone 727-825-1100
Mailing address
500 Dr Martin Luther King Jr St N Ste 303St Petersburg, FL 33705-1470
Phone 727-210-5253
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