Basic Information
| Provider Information | |||||||||
| NPI: | 1417938689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOPERA | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 CORPORATE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334266654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613694255 | ||||||||
| FaxNumber: | 9548389660 | ||||||||
| Practice Location | |||||||||
| Address1: | 3255 FOREST HILL BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334065854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619644577 | ||||||||
| FaxNumber: | 5613693254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME91277 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME91277 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P00307191 | 01 | RR MCR | OTHER | 271749200 | 05 | FL | MEDICAID | 50338 | 01 | FL | BCBS | OTHER |