Healthcare Provider Details

I. General information

NPI: 1245141597
Provider Name (Legal Business Name): ERIC ANTHONY SULLIVAN SA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ERIC LONG SA

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 ARAPAHOE AVE STE 110
BOULDER CO
80303-1089
US

IV. Provider business mailing address

4141 ARAPAHOE AVE STE 110
BOULDER CO
80303-1089
US

V. Phone/Fax

Practice location:
  • Phone: 303-447-9735
  • Fax:
Mailing address:
  • Phone: 303-447-9735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: