MEDICARE: REBECCA LEWIS KELSO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	M5279	TX

General Provider Information

NPI Number	:	1194876193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LEWIS KELSO M.D.

Provider Business Mailing Address
First Line	:	414 W SUNSET RD
Second Line	:	SUITE 210
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1756
Country	:	US
Telephone Number	:	210-255-8447
Fax Number	:	210-255-8446

Provider Business Practice Location Address
First Line	:	414 W SUNSET RD
Second Line	:	SUITE 210
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1756
Country	:	US
Telephone Number	:	210-255-8447
Fax Number	:	210-255-8446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	05/31/2013

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