| Doctor Name: | MARIE A LOPEZ |
| NPI Number: | 1003175621 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A. |
| License Number: | 002283 |
| Business Practice Address: | 625 S New Ballas Rd Saint Louis, MO - 631418253 |
| Business Phone Number: | 3142511648 |
| Business Fax Number: | |
| Mailing Address: | 625 S New Ballas Rd, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631418253 |
| Phone Number: | 3142511648 |
| Fax Number: | |
| NPI Enumeration Date: | 05/16/2012 |
| NPI Last Update Date: | 08/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 002283 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |