Provider Demographics
NPI:1952317232
Name:LOPEZ, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
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 1:204 W SCHUBERT ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-3847
Mailing Address - Country:US
Mailing Address - Phone:830-990-0255
Mailing Address - Fax:830-997-7569
Practice Address - Street 1:204 W SCHUBERT ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-3847
Practice Address - Country:US
Practice Address - Phone:830-990-0255
Practice Address - Fax:830-997-7569
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6963207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125442702Medicaid
TX4547005OtherAETNA PPO
TX83Z202OtherBLUECROSS/BLUE SHIELD TX.
TX924703OtherAETNA HMO
TX83Z202OtherBLUECROSS/BLUE SHIELD TX.
TX830004241Medicare PIN
TX125442702Medicaid