Mr Abraham Dagoberto Lopez Jr, PA in Phoenix, AZ - Medicare Physician Assistant

Mr Abraham Dagoberto Lopez Jr, PA is a medicare enrolled "Physician Assistant" physician in Phoenix, Arizona. His current practice location is 5102 W Campbell Ave, Phoenix, Arizona. You can reach out to his office (for appointments etc.) via phone at (623) 848-5000.

Mr Abraham Dagoberto Lopez Jr is licensed to practice in Arizona (license number 2816) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1073599619.

Contact Information

	Mr Abraham Dagoberto Lopez Jr, PA
	5102 W Campbell Ave, Phoenix, AZ 85031-1703
	(623) 848-5000
	Not Available

Physician's Profile

Full Name	Mr Abraham Dagoberto Lopez Jr
Gender	Male
Speciality	Physician Assistant
Location	5102 W Campbell Ave, Phoenix, Arizona
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1073599619
Provider Enumeration Date: 12/15/2005
Last Update Date: 12/22/2020

Medicare PECOS Information:

PECOS PAC ID: 6103802103
Enrollment ID: I20040629001111

Medical Identifiers

Medical identifiers for Mr Abraham Dagoberto Lopez Jr such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1073599619	NPI	-	NPPES
817827	Medicaid	AZ
860373636	Other	AZ	HUMANA-GROUP #
453051001	Other	AZ	GROUP HEALTH GROUP
3987220	Other	AZ	EYECARE
AW1436	Other	AZ	HEALTHNET GROUP

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207P00000X	Emergency Medicine	2816 (Arizona)	Secondary
363A00000X	Physician Assistant	2816 (Arizona)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Abraham Dagoberto Lopez Jr is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mr Abraham Dagoberto Lopez Jr, PA 4518 W Paradise Dr, Glendale, AZ 85304-3027 Ph: (602) 320-0580	Mr Abraham Dagoberto Lopez Jr, PA 5102 W Campbell Ave, Phoenix, AZ 85031-1703 Ph: (623) 848-5000

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Mr Abraham Dagoberto Lopez Jr, PA - Medicare Physician Assistant in Phoenix, AZ