1275702508 NPI number — DR DAVID N LOPEZ MD PA

Table of content: (NPI 1275702508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275702508 NPI number — DR DAVID N LOPEZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR DAVID N LOPEZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275702508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5282 MEDICAL DR
Provider Second Line Business Mailing Address:
STE 540
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-4849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-615-8495
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4910 GOLDEN QUAIL STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-615-8495
Provider Business Practice Location Address Fax Number:
210-615-8747
Provider Enumeration Date:
02/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
N
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
210-615-8495

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  H7570 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 167382401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167382402 . This is a "TH STEPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com