Provider Demographics
NPI:1275877383
Name:LOPEZ, EDGAR FRANCISCO (LSA)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:FRANCISCO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3540
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:7209 RIDGE CREEK DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5030
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137204246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8LV349OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TXSA00625OtherTEXAS MEDICAL BOARD
TX8LV187OtherBCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TX8LV328OtherXCITE SURGICAL LLC
TX8LV377OtherBCBC - UNIVERSAL SURGICAL PARTNERS