Provider Demographics
NPI:1215191259
Name:ANDERSON, CHARLES KELLOGG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KELLOGG
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6036
Mailing Address - Country:US
Mailing Address - Phone:541-683-5001
Mailing Address - Fax:541-683-1422
Practice Address - Street 1:520 COUNTRY CLUB PKWY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6036
Practice Address - Country:US
Practice Address - Phone:541-683-5001
Practice Address - Fax:541-683-1422
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125050891207V00000X
ORMD161964207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology