Individual
JOSE CARLOS LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATP
Contact information
Practice address
12406 STATE HIGHWAY 155 S, TYLER, TX 75703-6446
(903) 592-6760
Mailing address
12406 SH 155 SOUTH, TYLER, TX 75703
(903) 592-6760
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
ATP88042
TX
Other
Enumeration date
05/04/2017
Last updated
05/04/2017
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