Provider Demographics
NPI:1669415964
Name:KELLOGG, JORDI X (MD)
Entity type:Individual
Prefix:
First Name:JORDI
Middle Name:X
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9200 SE 91ST AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3756
Mailing Address - Country:US
Mailing Address - Phone:503-256-1462
Mailing Address - Fax:503-257-9523
Practice Address - Street 1:9200 SE 91ST AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086-3756
Practice Address - Country:US
Practice Address - Phone:503-256-1462
Practice Address - Fax:503-257-9523
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD22765207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31163Medicare UPIN