Provider Demographics
NPI:1255326989
Name:KELLUM, JOHN HANSFORD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HANSFORD
Last Name:KELLUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8920 US HIGHWAY 87 E
Mailing Address - Street 2:STE.# 3
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78263-2238
Mailing Address - Country:US
Mailing Address - Phone:210-648-0152
Mailing Address - Fax:210-649-4170
Practice Address - Street 1:3903 WISEMAN BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4401
Practice Address - Country:US
Practice Address - Phone:210-675-6724
Practice Address - Fax:210-675-1759
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2016-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0844207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115386801Medicaid
TXTXB150005Medicare PIN
TX8198J2Medicare PIN
TXF74361Medicare UPIN