Provider Demographics
NPI:1922032333
Name:KELLOGG, BREWSTER A (DO)
Entity Type:Individual
Prefix:DR
First Name:BREWSTER
Middle Name:A
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3716
Mailing Address - Country:US
Mailing Address - Phone:785-462-6184
Mailing Address - Fax:785-460-1490
Practice Address - Street 1:930 SW ABBEY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4820
Practice Address - Country:US
Practice Address - Phone:541-265-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0530778207Q00000X
ORDO198303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103904OtherBLUE CROSS
KS103981OtherBLUE CROSS
KS0530778OtherKANSAS LICENSE
KS200267690AMedicaid
KS103904Medicare PIN
KS103981OtherBLUE CROSS