Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 6454 | TX |
NPI | 1043551989 |
---|---|
Provider Name | Leonard Lopez |
First Address | The Colony, TX 75056-2808 |
Second Address | The Colony, TX 75056-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2013 |
Last Update Date | 01/03/2013 |