Healthcare Provider Details

I. General information

NPI: 1518943349
Provider Name (Legal Business Name): BARBARA M SULLIVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 BABCOCK RD STE 215
SAN ANTONIO TX
78201
US

IV. Provider business mailing address

PO BOX 101500
SAN ANTONIO TX
78201-9500
US

V. Phone/Fax

Practice location:
  • Phone: 210-733-4400
  • Fax: 210-733-4401
Mailing address:
  • Phone: 210-733-4400
  • Fax: 210-733-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberF4576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: