Individual
BRIAN C KELLOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13535 NEMOURS PKWY, ORLANDO, FL 32827-7402
(407) 567-4000
(407) 567-5924
Mailing address
10140 CENTURION PKWY N, JACKSONVILLE, FL 32256-0532
(904) 697-4127
(904) 697-5102
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35128432
OH
208200000X
Plastic Surgery Physician
Primary
ME137032
FL
2086S0122X
Plastic and Reconstructive Surgery Physician
35128432
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0222015
—
OH
05
—
100193900
—
FL
01
—
H556010
CGS-MEDICARE
OH
Enumeration date
05/12/2010
Last updated
03/18/2019
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