Provider Demographics
NPI:1700128188
Name:LOPEZ, ROSALIND (MD)
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N HIGHLAND AVE STE 542
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7390
Mailing Address - Country:US
Mailing Address - Phone:903-553-4353
Mailing Address - Fax:
Practice Address - Street 1:300 N HIGHLAND AVE STE 542
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7390
Practice Address - Country:US
Practice Address - Phone:903-553-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8290208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX359454106Medicaid
TX359454102Medicaid
TX359454103Medicaid
TX359454105Medicaid
TX359454104Medicaid