| |
4910 Golden Quail Ste 100 San Antonio TX 78240-1769 | |
(210) 615-8495 | |
(210) 615-8747 |
Full Name | |
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Speciality | Family Medicine |
Location | 4910 Golden Quail Ste 100, San Antonio, Texas |
Authorized Official Name and Position | David N Lopez (DOCTOR) |
Authorized Official Contact | 2106158495 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5282 Medical Dr Ste 540 San Antonio TX 78229-4849 Ph: (210) 615-8495 | 4910 Golden Quail Ste 100 San Antonio TX 78240-1769 Ph: (210) 615-8495 |
NPI Number | 1275702508 |
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Provider Enumeration Date | 02/20/2008 |
Last Update Date | 12/12/2019 |
Medicare PECOS PAC ID | 7517953136 |
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Medicare Enrollment ID | O20040421000322 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275702508 | NPI | - | NPPES |
167382401 | Medicaid | TX | |
167382402 | Other | TX | TH STEPS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | H7570 (Texas) | Primary |
Provider Name | David N Lopez |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1760418867 PECOS PAC ID: 6204822836 Enrollment ID: I20040421000574 |
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