Provider Demographics
NPI:1912227893
Name:LOPEZ VALLE, RAUL GUILLERMO (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:GUILLERMO
Last Name:LOPEZ VALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAUL
Other - Middle Name:GUILLERMO
Other - Last Name:LOPEZ VALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:900 GRANBERRY ST
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4757
Mailing Address - Country:US
Mailing Address - Phone:281-973-8049
Mailing Address - Fax:281-570-2943
Practice Address - Street 1:900 GRANBERRY ST
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4757
Practice Address - Country:US
Practice Address - Phone:281-973-8049
Practice Address - Fax:281-570-2943
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8153207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program