Provider Demographics
NPI:1043294283
Name:LOPEZ, RODOLFO A (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODOLFO
Other - Middle Name:A
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1400 MCKINNEY ST
Mailing Address - Street 2:SUITE 908
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77010-4023
Mailing Address - Country:US
Mailing Address - Phone:713-248-8528
Mailing Address - Fax:713-485-4370
Practice Address - Street 1:1400 MCKINNEY ST
Practice Address - Street 2:SUITE 908
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77010-4023
Practice Address - Country:US
Practice Address - Phone:713-248-8528
Practice Address - Fax:713-485-4370
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF89342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043294283Medicaid
VA017091C19Medicare PIN
TX8A2624Medicare ID - Type Unspecified
VA1043294283Medicaid