Provider Demographics
NPI:1417767385
Name:FAMILY MEDICINE CLINIC PLLC
Entity type:Organization
Organization Name:FAMILY MEDICINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:972-243-9607
Mailing Address - Street 1:10 MEDICAL PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7845
Mailing Address - Country:US
Mailing Address - Phone:972-243-9607
Mailing Address - Fax:972-488-3323
Practice Address - Street 1:10 MEDICAL PKWY STE 208
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7845
Practice Address - Country:US
Practice Address - Phone:972-243-9607
Practice Address - Fax:972-488-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty