Provider Demographics
NPI:1881696227
Name:CHERYL P LOPEZ DO PA
Entity type:Organization
Organization Name:CHERYL P LOPEZ DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:PAN
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-618-7952
Mailing Address - Street 1:3880 PARKWOOD BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1928
Mailing Address - Country:US
Mailing Address - Phone:214-618-7952
Mailing Address - Fax:214-618-7991
Practice Address - Street 1:3880 PARKWOOD BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1928
Practice Address - Country:US
Practice Address - Phone:214-618-7952
Practice Address - Fax:214-618-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0939472OtherCLIA
TX1076462OtherFIRST HEALTH INSURANCE
TX527359OtherDESERET MUTUAL INSURANCE
TX82610FOtherBCBS OF TX
TXP082610FDMedicaid
TX0041BHOtherBCBS OF TX (GROUP ID #)
TX5018550OtherAETNA INSURANCE
TX21149563445OtherBEECHSTREET INSURANCE
TX1015218OtherAETNA INSURANCE
TX104282OtherHEALTH PARTNERS CLAIM
TX7240640007OtherCIGNA INSURANCE
TX147888807OtherUNITED HEALTHCARE
TX2559446OtherHEALTHMARKET INSURANCE
TXP000047281OtherNORTHTEXAS HEALTH NETWORK