=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811904105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORGE FRANCISCO LOPEZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 11/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7777 FOREST LN BUILDING C, SUITE 538
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-566-8787
-----------------------------------------------------
Fax | 972-566-8764
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7777 FOREST LN. SUITE C-806
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-6865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-566-8787
-----------------------------------------------------
Fax | 972-566-8764
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | J6552
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------