Provider Demographics
NPI:1154611978
Name:KELLOGG, WINDELL CURTIS (IDC)
Entity type:Individual
Prefix:MR
First Name:WINDELL
Middle Name:CURTIS
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JUNGLE WARFARE TRAINING CENTER, CAMP GONSALVES
Mailing Address - Street 2:UNIT 3591
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JUNGLE WARFARE TRAINING CENTER, CAMP GONSALVES
Practice Address - Street 2:UNIT 3591
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96602
Practice Address - Country:US
Practice Address - Phone:361-249-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman