MEDICARE: DR. GABRIEL LOPEZ M.D.

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	174400000X	Specialist	L9326	TX
2	208VP0014X	Interventional Pain Medicine Physician	L9326	TX

General Provider Information

NPI Number	:	1801814165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL LOPEZ M.D.

Provider Business Mailing Address
First Line	:	4833 SARATOGA BLVD # 272
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-2213
Country	:	US
Telephone Number	:	361-991-0704
Fax Number	:	361-993-1143

Provider Business Practice Location Address
First Line	:	3825 S PADRE ISLAND DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-2913
Country	:	US
Telephone Number	:	361-225-0089
Fax Number	:	361-225-0017

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/09/2010

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