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Dr. Luis Angel Lopezrivera, MD
General Practice Physician in Crestview, Florida
NPI 1174713184

Luis Angel Lopezrivera is a General Practice Physician based in Crestview, FL. Luis Angel Lopezrivera practices in Crestview, FL and has the professional credentials of MD. The NPI Number for Luis Angel Lopezrivera is 1174713184 and holds a License No. 17506 (Florida).

The current practice location address for Luis Angel Lopezrivera is 3189 Colonel Greg Malloy Rd, Crestview, FL and can be reached out via phone at 850-683-4042.

Location: 3189 Colonel Greg Malloy Rd, Crestview, FL, 32539-9060
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1174713184
Provider Name
Luis Angel Lopezrivera
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
3189 Colonel Greg Malloy Rd, Crestview, FL, 32539-9060
Phone Number
850-683-4042
Fax Number
Provider Enumeration Date
07/26/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
007626400 05 FL
institution
Provider Business Practice Location Address Details
Address
3189 Colonel Greg Malloy Rd
City
Crestview
State
Florida
Zip
32539-6705
Phone Number
850-683-4042
Fax Number
person
Provider Business Mailing Address Details
Address
3189 Colonel Greg Malloy Rd
City
Crestview
State
Florida
Zip
32539-6705
Phone Number
850-683-4042
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
17506 ()
Definition
Definition to come...
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