Healthcare Provider Details

I. General information

NPI: 1386668127
Provider Name (Legal Business Name): JOSEPH FRANCIS SULLIVAN JOSEPH SULLIVAN, M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 7TH AVE S
NAPLES FL
34102-6715
US

IV. Provider business mailing address

811 7TH AVE S
NAPLES FL
34102-6715
US

V. Phone/Fax

Practice location:
  • Phone: 239-263-6620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME11859
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: