MEDICARE: OMAR LOPEZ-FLORES APRN

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	208800000X	Urology Physician	1206448	TX

General Provider Information

NPI Number	:	1720930613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR LOPEZ-FLORES APRN

Provider Business Mailing Address
First Line	:	3962 FARRIS CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1210
Country	:	US
Telephone Number	:	817-784-8268
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 CLEARFORK MAIN ST STE 420
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3569
Country	:	US
Telephone Number	:	817-784-8268
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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