Organization
KELLUM PHYSICIAN PARTNERS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL HANSFORD KELLUM JR. M.D. (PRESIDENT)
(210) 945-2121
Entity
Organization
Contact information
Practice address
3903 WISEMAN BLVD, SUITE 215, SAN ANTONIO, TX 78251-4401
(210) 675-6724
(210) 675-1759
Mailing address
8870 US HIGHWAY 87 E, SAN ANTONIO, TX 78263-2242
(210) 648-0152
(210) 649-4170
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
J1533
TX
207V00000X
Obstetrics & Gynecology Physician
Primary
J0844
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3009748-01
—
TX
Enumeration date
11/18/2011
Last updated
04/07/2015
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