Provider Demographics
NPI:1073892071
Name:LOPEZ, MARCO A (MD)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402. E. NOLANA LOOP SUITE A
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577
Mailing Address - Country:US
Mailing Address - Phone:956-601-0831
Mailing Address - Fax:956-601-0831
Practice Address - Street 1:1402 E NOLANA LOOP SUITE A
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-601-0831
Practice Address - Fax:956-601-0831
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0849208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics