Healthcare Provider Details

I. General information

NPI: 1508092016
Provider Name (Legal Business Name): ROGELIO LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S. AIRPORT SUITE E
WESLACO TX
78596
US

IV. Provider business mailing address

415 S. AIRPORT SUITE E
WESLACO TX
78596
US

V. Phone/Fax

Practice location:
  • Phone: 956-973-5024
  • Fax: 956-973-5064
Mailing address:
  • Phone: 956-973-5024
  • Fax: 956-973-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD8756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: