Individual
CLINT W KELLOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3600 AMRON CT, COLUMBIA, MO 65202
(573) 874-1616
(573) 875-0300
Mailing address
3600 AMRON CT, COLUMBIA, MO 65202-1918
(573) 874-1616
(573) 875-0300
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Q9396
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
2018010581
MO
Other
Enumeration date
04/30/2013
Last updated
03/18/2021
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