Healthcare Provider Details

I. General information

NPI: 1194968834
Provider Name (Legal Business Name): ALAN CHRISTOPHER SULL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SANTA MONICA BLVD STE 400
SANTA MONICA CA
90404-2139
US

IV. Provider business mailing address

525 BROADWAY UNIT 4031
SANTA MONICA CA
90401-2478
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA113220
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number22265
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA113220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: