Provider Demographics
NPI:1619113883
Name:EVA J LOPEZ MD PA
Entity type:Organization
Organization Name:EVA J LOPEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-912-9322
Mailing Address - Street 1:GC PHYSICIAN SERVICES
Mailing Address - Street 2:2318 SAN PEDRO AVE STE 12
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1901
Mailing Address - Country:US
Mailing Address - Phone:210-259-6338
Mailing Address - Fax:386-204-7372
Practice Address - Street 1:2318 SAN PEDRO AVE STE 12
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1901
Practice Address - Country:US
Practice Address - Phone:210-259-6338
Practice Address - Fax:386-204-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00850TMedicare PIN