Provider Demographics
NPI:1275608606
Name:LOPEZ, ELSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 S GENERAL BRUCE DR
Mailing Address - Street 2:SUITE 75
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1469
Mailing Address - Country:US
Mailing Address - Phone:254-743-1608
Mailing Address - Fax:
Practice Address - Street 1:4501 S GENERAL BRUCE DR
Practice Address - Street 2:SUITE 75
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1469
Practice Address - Country:US
Practice Address - Phone:254-743-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine