Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 12440 | CA |
N | 2251E1300X | Electrophysiology, Clinical | 00025 | CA |
NPI | 1417927831 |
---|---|
Provider Name | Dr. Robert Michael Kellogg |
First Address | Rota, CADIZ FPO AE 09645 |
Second Address | Rota, CADIZ FPO AE 09645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 08/07/2007 |