Provider Demographics
NPI:1962498121
Name:LOPEZ, ALEJANDRO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:
Last Name:LOPEZ
Suffix:JR
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 1:201 MARIPOSA
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4177
Mailing Address - Country:US
Mailing Address - Phone:361-664-8811
Mailing Address - Fax:361-664-8992
Practice Address - Street 1:201 MARIPOSA
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4177
Practice Address - Country:US
Practice Address - Phone:361-664-8811
Practice Address - Fax:361-664-8992
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-07-01
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
TXG3569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122456001Medicaid
TX122456001Medicaid
TXD97501Medicare UPIN