Provider Demographics
NPI:1801087093
Name:LOPEZ, DANIEL ESTEBAN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ESTEBAN
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 1:5 ADDISON CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5511
Mailing Address - Country:US
Mailing Address - Phone:217-621-5907
Mailing Address - Fax:
Practice Address - Street 1:5 ADDISON CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5511
Practice Address - Country:US
Practice Address - Phone:217-621-5907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN95922086S0129X, 208600000X
PAMD4822472086S0129X
WYTL31022086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303099101Medicaid
TXTXB158147Medicare PIN