Individual
DR. LISA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
K2952
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1446569-01
—
TX
01
—
1446569-02
CSHCN
TX
01
—
220030865
RR/MEDICARE
TX
01
—
8B4704
BLUE SHIELD
TX
Enumeration date
03/29/2006
Last updated
10/02/2020
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