Healthcare Provider Details

I. General information

NPI: 1356321475
Provider Name (Legal Business Name): PATRICK T SULLIVAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 WRIGHT ST
ARLINGTON TX
76012-4730
US

IV. Provider business mailing address

14275 MIDWAY RD SUITE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 817-460-4366
  • Fax: 817-469-7563
Mailing address:
  • Phone:
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberF7978
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: