Healthcare Provider Details

I. General information

NPI: 1043494032
Provider Name (Legal Business Name): HECTOR URIEL LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SPURS LN STE 300
SAN ANTONIO TX
78240-1679
US

IV. Provider business mailing address

21 SPURS LN STE 300
SAN ANTONIO TX
78240-1679
US

V. Phone/Fax

Practice location:
  • Phone: 210-699-8326
  • Fax: 210-561-7121
Mailing address:
  • Phone: 210-699-8326
  • Fax: 210-561-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberN3844
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number40756
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: