Healthcare Provider Details

I. General information

NPI: 1124071949
Provider Name (Legal Business Name): JOHN E SULLIVAN JR. M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 BEE RIDGE RD
SARASOTA FL
34239-6304
US

IV. Provider business mailing address

2439 BEE RIDGE RD
SARASOTA FL
34239-6304
US

V. Phone/Fax

Practice location:
  • Phone: 941-955-8076
  • Fax: 941-955-0453
Mailing address:
  • Phone: 941-955-8076
  • Fax: 941-955-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME43835
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: