MEDICARE: JF LOPEZ DDS, MD, RPH, 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	19857	TX

General Provider Information

NPI Number	:	1760522098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JF LOPEZ DDS, MD, RPH, PA

Provider Business Mailing Address
First Line	:	1770 SAINT JAMES PL
Second Line	:	SUITE 512
City	:	HOUSTON
State	:	TX
Zip	:	77056-3471
Country	:	US
Telephone Number	:	713-622-8607
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 SAINT JAMES PL
Second Line	:	SUITE 512
City	:	HOUSTON
State	:	TX
Zip	:	77056-3471
Country	:	US
Telephone Number	:	713-622-8607
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE F LOPEZ
Credential	:	DDS, MD
Telephone Number	:	713-622-8607

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	01/06/2009

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