Provider Demographics
NPI:1447696315
Name:LOPEZ DAVILA, TYRONE J SR (MD)
Entity type:Individual
Prefix:DR
First Name:TYRONE
Middle Name:J
Last Name:LOPEZ DAVILA
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:786-621-7817
Practice Address - Street 1:1490 NW 27TH AVE STE 130
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2173
Practice Address - Country:US
Practice Address - Phone:305-635-7710
Practice Address - Fax:786-621-7817
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2022-04-19
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Provider Licenses
StateLicense IDTaxonomies
PR020572208D00000X
FLACN546208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019601500Medicaid