Individual
JENNIFER LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-1173
Mailing address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
S6677
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2018
Last updated
07/06/2022
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