Provider Demographics
NPI:1083612303
Name:LOPEZ, JEROME E (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:321 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7378
Mailing Address - Country:US
Mailing Address - Phone:903-893-5141
Mailing Address - Fax:903-891-4285
Practice Address - Street 1:321 N HIGHLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7378
Practice Address - Country:US
Practice Address - Phone:903-893-5141
Practice Address - Fax:903-891-4285
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK96012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100249120AMedicaid
TX130021486OtherRAILROAD MEDICARE
TX130021486OtherRAILROAD MEDICARE
TXH11172Medicare UPIN