Provider Demographics
NPI:1730279068
Name:LOPEZ, EVA JEANETTE (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:JEANETTE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:GC PHYSICIAN SERVICES
Mailing Address - Street 2:2318 SAN PEDRO STE 12
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1901
Mailing Address - Country:US
Mailing Address - Phone:210-257-8437
Mailing Address - Fax:386-204-7372
Practice Address - Street 1:5401 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2150
Practice Address - Country:US
Practice Address - Phone:210-259-6338
Practice Address - Fax:386-204-7372
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-9796207R00000X
TXH4499207R00000X, 2083B0002X
NE30368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E51590Medicare UPIN