Provider Demographics
NPI:1861456550
Name:LOPEZ-ROMAN, HENRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:LOPEZ-ROMAN
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 1:2100 REGIONAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-9719
Mailing Address - Country:US
Mailing Address - Phone:979-532-1700
Mailing Address - Fax:979-532-6754
Practice Address - Street 1:2100 REGIONAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-9719
Practice Address - Country:US
Practice Address - Phone:979-532-1700
Practice Address - Fax:979-532-6754
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8674207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139255704Medicaid
TX139255717Medicaid
TX830003057OtherRAILROAD GBA - RAILROAD MEDICARE
TX89Z781OtherBC/BS TX#
TX8DE535OtherBC/BS #
TXP01090501OtherRAILROAD MEDICARE PTAN
TX8DE535OtherBC/BS #
TX830003057OtherRAILROAD GBA - RAILROAD MEDICARE
TXP01090501OtherRAILROAD MEDICARE PTAN