MEDICARE: RODOLFO A. LOPEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	F8934	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043294283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODOLFO A. LOPEZ M.D.

Provider Business Mailing Address
First Line	:	1400 MCKINNEY ST
Second Line	:	SUITE 908
City	:	HOUSTON
State	:	TX
Zip	:	77010-4023
Country	:	US
Telephone Number	:	713-248-8528
Fax Number	:	713-485-4370

Provider Business Practice Location Address
First Line	:	1400 MCKINNEY ST
Second Line	:	SUITE 908
City	:	HOUSTON
State	:	TX
Zip	:	77010-4023
Country	:	US
Telephone Number	:	713-248-8528
Fax Number	:	713-485-4370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	01/30/2014

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