Provider Demographics
NPI:1619170347
Name:GRESHAM, JOHN KENNEDY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNEDY
Last Name:GRESHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:540 OAK CENTRE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4767
Mailing Address - Country:US
Mailing Address - Phone:210-499-0448
Mailing Address - Fax:210-370-9638
Practice Address - Street 1:540 OAK CENTRE DR STE 260
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4767
Practice Address - Country:US
Practice Address - Phone:210-499-0448
Practice Address - Fax:210-370-9638
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM6641207RI0011X, 207RC0000X, 207UN0901X
VA0101230320207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology