MEDICARE: DR. ROBERTO LOPEZ D.O.

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	207R00000X	Internal Medicine Physician	J2168	TX

General Provider Information

NPI Number	:	1144279373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO LOPEZ D.O.

Provider Business Mailing Address
First Line	:	7501 LAKEVIEW PKWY STE 220
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75088-9323
Country	:	US
Telephone Number	:	469-800-2475
Fax Number	:	469-800-3340

Provider Business Practice Location Address
First Line	:	7501 LAKEVIEW PKWY
Second Line	:	SUITE 220
City	:	ROWLETT
State	:	TX
Zip	:	75088-9323
Country	:	US
Telephone Number	:	469-800-2475
Fax Number	:	469-800-3340

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	04/05/2022

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