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NPI Code Detail

MEDICARE: DR. GREGORY IVAN KELTS MD

MEDICARE: DR. GREGORY IVAN KELTS MD
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
1207Y00000XOtolaryngology PhysicianU1311TX
2207YX0905XOtolaryngology/Facial Plastic Surgery PhysicianU1311TX

General Provider Information

NPI Number : 1144529066
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY IVAN KELTS MD
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 443-481-8687
Fax Number : 443-481-8687
Provider Business Practice Location Address
First Line : 3320 OAKWELL CT
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78218-3128
Country : US
Telephone Number : 210-829-5180
Fax Number : 210-829-5030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2011
Last Update Date : 07/01/2024

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