Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | M2695 | TX |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | M2695 | TX |
NPI | 1770505984 |
---|---|
Provider Name | Manuel Antonio Lopez |
First Address | San Antonio, TX 78259-0140 |
Second Address | San Antonio, TX 78258-4196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H96370 | (02) | TX |