Healthcare Provider Details

I. General information

NPI: 1336249283
Provider Name (Legal Business Name): DAVID E. SULLIVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W 6TH ST
RENO NV
89503-4548
US

IV. Provider business mailing address

PO BOX 21418
RENO NV
89515-1418
US

V. Phone/Fax

Practice location:
  • Phone: 775-746-3202
  • Fax: 775-746-1904
Mailing address:
  • Phone: 775-746-3202
  • Fax: 775-746-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10700
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: