Provider Demographics
NPI:1942265533
Name:LOPEZ, MANUEL D (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:D
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10201 GATEWAY BLVD W
Mailing Address - Street 2:#210
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7652
Mailing Address - Country:US
Mailing Address - Phone:915-591-2922
Mailing Address - Fax:915-591-0495
Practice Address - Street 1:10201 GATEWAY BLVD W
Practice Address - Street 2:#210
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7652
Practice Address - Country:US
Practice Address - Phone:915-591-2922
Practice Address - Fax:915-591-0495
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8303207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0314213-01Medicaid
TX031421302Medicaid
TX0314213-01Medicaid
TX8F7700Medicare PIN
TX0092AAMedicare PIN