Provider Demographics
NPI:1205820990
Name:KELLUM, DANIEL H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
Last Name:KELLUM
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:8870 US HIGHWAY 87 E
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78263-2242
Mailing Address - Country:US
Mailing Address - Phone:210-648-0152
Mailing Address - Fax:210-649-4170
Practice Address - Street 1:3401 FM 3009
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2711
Practice Address - Country:US
Practice Address - Phone:210-945-2121
Practice Address - Fax:210-945-2221
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133204105Medicaid
TXTXB150032Medicare PIN
TXF40072Medicare UPIN
TX8198J1Medicare PIN