Individual
JAIME LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
6550 FANNIN ST, SUITE 1401, HOUSTON, TX 77030-2717
(713) 441-6201
Mailing address
6550 FANNIN ST, SUITE 1401, HOUSTON, TX 77030-2717
(713) 441-6201
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06540
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922322437
BLUE CROSS BLUE SHIELD
TX
05
—
212991801
—
TX
Enumeration date
03/26/2010
Last updated
04/09/2012
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