Healthcare Provider Details

I. General information

NPI: 1215363544
Provider Name (Legal Business Name): KELLUM PHYSICIAN PARTNERS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8870 US HIGHWAY 87 E
SAN ANTONIO TX
78263-2242
US

IV. Provider business mailing address

8870 US HIGHWAY 87 E
SAN ANTONIO TX
78263-2242
US

V. Phone/Fax

Practice location:
  • Phone: 210-945-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JULIA FLORES
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 210-675-6724