Basic Information
| Provider Information | |||||||||
| NPI: | 1316350697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | JERONIMO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4011 E SILVER SPRINGS BLVD | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344705098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522610400 | ||||||||
| FaxNumber: | 8443886186 | ||||||||
| Practice Location | |||||||||
| Address1: | 4011 E SILVER SPRINGS BLVD | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344705098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522610400 | ||||||||
| FaxNumber: | 8443886186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2014 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME120658 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.