Provider Demographics
NPI:1538549910
Name:LOPEZ, LEONEL JULIAN III (MD)
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:JULIAN
Last Name:LOPEZ
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 DIETRICH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78219-2873
Mailing Address - Country:US
Mailing Address - Phone:210-644-3050
Mailing Address - Fax:210-702-6994
Practice Address - Street 1:4711 DIETRICH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-2873
Practice Address - Country:US
Practice Address - Phone:201-644-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT4552207Q00000X
CT61133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine