Provider Demographics
NPI:1770505984
Name:LOPEZ, MANUEL ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANTONIO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 591819
Mailing Address - Street 2:STE 5104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0140
Mailing Address - Country:US
Mailing Address - Phone:210-495-5771
Mailing Address - Fax:210-495-0155
Practice Address - Street 1:18322 SONTERRA PL
Practice Address - Street 2:STE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4196
Practice Address - Country:US
Practice Address - Phone:830-328-4206
Practice Address - Fax:210-966-9106
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-11-30
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Provider Licenses
StateLicense IDTaxonomies
TXM2695207Y00000X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F8590Medicare PIN
TXH96370Medicare UPIN