Healthcare Provider Details

I. General information

NPI: 1083612303
Provider Name (Legal Business Name): JEROME E LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N HIGHLAND AVE SUITE 200
SHERMAN TX
75092-7378
US

IV. Provider business mailing address

321 N HIGHLAND AVE SUITE 200
SHERMAN TX
75092-7378
US

V. Phone/Fax

Practice location:
  • Phone: 903-893-5141
  • Fax: 903-891-4285
Mailing address:
  • Phone: 903-893-5141
  • Fax: 903-891-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberK9601
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: