=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275702508
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR DAVID N LOPEZ MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2008
-----------------------------------------------------
Last Update Date | 12/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4910 GOLDEN QUAIL STE 100
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-1769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-615-8495
-----------------------------------------------------
Fax | 210-615-8747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5282 MEDICAL DR STE 540
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-615-8495
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. DAVID N LOPEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 210-615-8495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | H7570
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------