MEDICARE: EVA J LOPEZ MD PA

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	207R00000X	Internal Medicine Physician	H4499	TX

General Provider Information

NPI Number	:	1619113883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVA J LOPEZ MD PA

Provider Business Mailing Address
First Line	:	GC PHYSICIAN SERVICES
Second Line	:	2318 SAN PEDRO AVE STE 12
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-1901
Country	:	US
Telephone Number	:	210-259-6338
Fax Number	:	386-204-7372

Provider Business Practice Location Address
First Line	:	2318 SAN PEDRO AVE STE 12
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-1901
Country	:	US
Telephone Number	:	210-259-6338
Fax Number	:	386-204-7372

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	EVA JEANETTE LOPEZ
Credential	:	MD
Telephone Number	:	210-912-9322

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	08/11/2022

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