Provider Demographics
NPI:1457304693
Name:LOPEZ, WILLIAM MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MANUEL
Last Name:LOPEZ
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 1:1640 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4515
Mailing Address - Country:US
Mailing Address - Phone:952-996-2176
Mailing Address - Fax:877-733-8380
Practice Address - Street 1:1640 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4515
Practice Address - Country:US
Practice Address - Phone:952-996-2176
Practice Address - Fax:877-733-8380
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012268772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG12967Medicare UPIN