MEDICARE: DR. DANIEL H KELLUM JR. 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
1	207Q00000X	Family Medicine Physician	J1533	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205820990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL H KELLUM JR. MD

Provider Business Mailing Address
First Line	:	8870 US HIGHWAY 87 E
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78263-2242
Country	:	US
Telephone Number	:	210-648-0152
Fax Number	:	210-649-4170

Provider Business Practice Location Address
First Line	:	3401 FM 3009
Second Line	:
City	:	SCHERTZ
State	:	TX
Zip	:	78154-2711
Country	:	US
Telephone Number	:	210-945-2121
Fax Number	:	210-945-2221

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	04/07/2015

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