MEDICARE: RANDOLPH A LOPEZ 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	207XS0106X	Orthopaedic Hand Surgery Physician	M0474	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8U4390	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1780789719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDOLPH A LOPEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 73547
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77273
Country	:	US
Telephone Number	:	713-812-1612
Fax Number	:	281-537-7371

Provider Business Practice Location Address
First Line	:	3726 DACOMA
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092
Country	:	US
Telephone Number	:	713-812-1612
Fax Number	:	281-537-7371

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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