Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | M7379 | TX |
NPI | 1003083395 |
---|---|
Provider Name | Dr. Alfredo Ruben Lopez |
First Address | Dallas, TX 75284-0853 |
Second Address | Dallas, TX 75240-6524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
197404001 | (05) | TX |
197404004 | (05) | TX |
197404005 | (05) | TX |
8DN655 | BCBS (01) | TX |
8EH547 | BCBS TX (01) | TX |