Provider Demographics
NPI:1932398690
Name:LOPEZ FAMILY PRACTICE
Entity Type:Organization
Organization Name:LOPEZ FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-921-6088
Mailing Address - Street 1:601 LABOR ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1313
Mailing Address - Country:US
Mailing Address - Phone:210-921-6088
Mailing Address - Fax:210-921-6019
Practice Address - Street 1:601 LABOR ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1313
Practice Address - Country:US
Practice Address - Phone:210-921-6088
Practice Address - Fax:210-921-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00203QOtherBCBS OF TX
TX144083601Medicaid
TX00203QMedicare PIN
TXG53860Medicare UPIN