Provider Demographics
NPI:1861167462
Name:LOPEZ, VICTOR ANTONIO III (IDMT)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:ANTONIO
Last Name:LOPEZ
Suffix:III
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:IRAAN
Mailing Address - State:TX
Mailing Address - Zip Code:79744
Mailing Address - Country:US
Mailing Address - Phone:432-302-0471
Mailing Address - Fax:
Practice Address - Street 1:WEST 9TH ST 619
Practice Address - Street 2:
Practice Address - City:IRAAN
Practice Address - State:TX
Practice Address - Zip Code:79744
Practice Address - Country:US
Practice Address - Phone:432-402-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians