MEDICARE: SAMANTHA NICOLE LOPEZ KROGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	W5850	TX

General Provider Information

NPI Number	:	1275277303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA NICOLE LOPEZ KROGER MD

Provider Business Mailing Address
First Line	:	111 W DAVIS ST APT 2535
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4485
Country	:	US
Telephone Number	:	214-534-4298
Fax Number	:

Provider Business Practice Location Address
First Line	:	5939 HARRY HINES BLVD FL 4
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6246
Country	:	US
Telephone Number	:	214-756-6550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	06/01/2026

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