Provider Demographics
NPI:1902906621
Name:LOPEZ, ARTHUR GARDUQUE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:GARDUQUE
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2121 S CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4110
Mailing Address - Country:US
Mailing Address - Phone:254-634-9111
Mailing Address - Fax:254-634-7719
Practice Address - Street 1:2121 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-634-9111
Practice Address - Fax:254-634-7719
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4340207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000AD616Medicaid
TXP000AD616Medicaid