MEDICARE: DR. JASON MURRAY SULLIVAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD0031354	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528047586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON MURRAY SULLIVAN MD

Provider Business Mailing Address
First Line	:	668 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3951
Country	:	US
Telephone Number	:	731-424-2414
Fax Number	:	731-424-4444

Provider Business Practice Location Address
First Line	:	668 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3951
Country	:	US
Telephone Number	:	731-424-2414
Fax Number	:	731-424-4444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	11/15/2007

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