Provider Demographics
NPI:1447225768
Name:KELLOGG, JULIE AMELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:AMELIA
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:AMELIA
Other - Last Name:OHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2627 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4712
Mailing Address - Country:US
Mailing Address - Phone:904-308-7372
Mailing Address - Fax:904-308-2908
Practice Address - Street 1:2627 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4712
Practice Address - Country:US
Practice Address - Phone:904-308-7372
Practice Address - Fax:904-308-2908
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043647A208000000X
FLME127399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics