MEDICARE: LEONEL JULIAN LOPEZ III MD

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	207Q00000X	Family Medicine Physician	T4552	TX

General Provider Information

NPI Number	:	1538549910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONEL JULIAN LOPEZ III MD

Provider Business Mailing Address
First Line	:	3611 JAGUAR PKWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78224-3271
Country	:	US
Telephone Number	:	726-236-9560
Fax Number	:	210-702-6896

Provider Business Practice Location Address
First Line	:	4702 E HOUSTON ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-1720
Country	:	US
Telephone Number	:	210-644-2050
Fax Number	:	210-702-6400

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

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	01/05/2026

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