Provider Demographics
NPI:1649368499
Name:LOPEZ, PAUL DAVID (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:731 MARTIN RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2703
Practice Address - Country:US
Practice Address - Phone:817-514-0346
Practice Address - Fax:817-514-0885
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7048208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1237859OtherFIRSTHEALTH PIN
TX1879100OtherUHC PIN
TX101475100OtherFIRSTCARE PIN
TX137283108Medicaid
1750369203OtherGRP NPI NUMBER
TX5753735OtherAETNA PIN
TXLOPDG78809OtherCCHIP PIN
TX9062981OtherPHCS PIN
TX140442852Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TX116331304Medicaid
TX87073GOtherBCBSTX IND PIN
G78809Medicare UPIN
TX140442852Medicaid
TX8A7449Medicare PIN