Provider Demographics
NPI:1619974045
Name:LOPEZ, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
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 1:359 E HILDEBRAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2453
Mailing Address - Country:US
Mailing Address - Phone:210-320-1166
Mailing Address - Fax:210-320-1295
Practice Address - Street 1:359 E HILDEBRAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2453
Practice Address - Country:US
Practice Address - Phone:210-320-1166
Practice Address - Fax:210-320-1295
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6109207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG71961Medicare UPIN
TX83580JMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
TX83580JMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
TXG71961Medicare UPIN
TX00F22EMedicare ID - Type UnspecifiedGROUP MEDICARE #
TX042124001Medicaid
TX082431001Medicaid