Provider Demographics
NPI:1295399277
Name:LOPEZ, GLADYS (DO)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S HAMPTON RD STE 900
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1677
Mailing Address - Country:US
Mailing Address - Phone:214-330-9201
Mailing Address - Fax:214-339-9577
Practice Address - Street 1:2301 S HAMPTON RD STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1677
Practice Address - Country:US
Practice Address - Phone:214-330-9201
Practice Address - Fax:214-339-9577
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10067054207Q00000X
TXT4967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10067054OtherTEXAS MEDICAL BOARD