MEDICARE: WILLIAM MANUEL LOPEZ M.D.

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	2084P0800X	Psychiatry Physician	0101226877	VA

General Provider Information

NPI Number	:	1457304693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MANUEL LOPEZ M.D.

Provider Business Mailing Address
First Line	:	1640 DALLAS PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4515
Country	:	US
Telephone Number	:	952-996-2176
Fax Number	:	877-733-8380

Provider Business Practice Location Address
First Line	:	1640 DALLAS PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4515
Country	:	US
Telephone Number	:	952-996-2176
Fax Number	:	877-733-8380

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/03/2012

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