MEDICARE: ALFREDO LOPEZ JR MD PA

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	K5339	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0031MA	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588732127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALFREDO LOPEZ JR MD PA

Provider Business Mailing Address
First Line	:	2010 S CYNTHIA ST STE 110
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78503-1387
Country	:	US
Telephone Number	:	956-687-6963
Fax Number	:	956-683-7185

Provider Business Practice Location Address
First Line	:	2010 S CYNTHIA ST STE 110
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78503-1387
Country	:	US
Telephone Number	:	956-687-6963
Fax Number	:	956-683-7185

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALFREDO LOPEZ JR.
Credential	:	MD
Telephone Number	:	956-687-6963

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	12/29/2010

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