Provider Demographics
NPI:1992863518
Name:ELMER, KATHLEEN BEVERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:BEVERLY
Last Name:ELMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:15900 LA CANTERA PKWY STE 20270
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2471
Mailing Address - Country:US
Mailing Address - Phone:210-641-9500
Mailing Address - Fax:210-641-9501
Practice Address - Street 1:15900 LA CANTERA PKWY STE 20270
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2471
Practice Address - Country:US
Practice Address - Phone:210-641-9500
Practice Address - Fax:210-641-9501
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60600179207N00000X
FLME58935207N00000X
TXR7724207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology