Provider Demographics
NPI:1508092016
Name:LOPEZ, ROGELIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:
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 1:415 S. AIRPORT SUITE E
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-973-5024
Mailing Address - Fax:956-973-5064
Practice Address - Street 1:415 S. AIRPORT SUITE E
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-973-5024
Practice Address - Fax:956-973-5064
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics