Individual
JEFFREY L. KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4545 SERGEANT RD, SIOUX CITY, IA 51106-4706
(712) 274-2400
(712) 274-1484
Mailing address
814 PIERCE ST, STE102, SIOUX CITY, IA 51101-1061
(712) 226-2600
(712) 226-2605
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02201
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1098830
—
IA
01
—
70220
WELLMARK OF IA
IA
05
—
7764992
—
SD
Enumeration date
06/14/2006
Last updated
01/31/2011
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