Provider Demographics
NPI:1225091952
Name:LOPERA, JORGE E (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:LOPERA
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 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MAIL CODE 7800
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-567-5564
Mailing Address - Fax:210-567-5541
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:MAIL CODE 7800
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-5564
Practice Address - Fax:210-567-5541
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407212085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173151501Medicaid
TX8E0553Medicare ID - Type Unspecified
TX173151501Medicaid