Provider Demographics
NPI:1528011616
Name:LOPEZ, KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
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 1:2222 WELBORN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3924
Mailing Address - Country:US
Mailing Address - Phone:214-559-5000
Mailing Address - Fax:214-443-7309
Practice Address - Street 1:7000 W PLANO PKWY
Practice Address - Street 2:STE. 110
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8466
Practice Address - Country:US
Practice Address - Phone:469-515-7100
Practice Address - Fax:214-443-7309
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5104207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151232901Medicaid
TX151232901Medicaid
TX8861N2Medicare ID - Type UnspecifiedMEDICARE