Provider Demographics
NPI:1134439383
Name:MARCO A. LOPEZ, JR. M,D.P.A.
Entity type:Organization
Organization Name:MARCO A. LOPEZ, JR. M,D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-4963
Mailing Address - Street 1:4499 MEDICAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3851
Mailing Address - Country:US
Mailing Address - Phone:210-614-4963
Mailing Address - Fax:210-615-1758
Practice Address - Street 1:4499 MEDICAL DR STE 306
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3851
Practice Address - Country:US
Practice Address - Phone:210-614-4963
Practice Address - Fax:210-615-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2045207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty