Provider Demographics
NPI:1154400489
Name:LOPEZ-GLYNN, MICHELE M (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:M
Last Name:LOPEZ-GLYNN
Suffix:
Gender:F
Credentials:MD
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 735
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78156-0735
Mailing Address - Country:US
Mailing Address - Phone:830-303-3400
Mailing Address - Fax:830-303-3401
Practice Address - Street 1:1005 E COURT ST
Practice Address - Street 2:STE 300
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5843
Practice Address - Country:US
Practice Address - Phone:830-303-3400
Practice Address - Fax:830-303-3401
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7015208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics