Healthcare Provider Details

I. General information

NPI: 1972709368
Provider Name (Legal Business Name): ARTHUR FRANCIS SULLIVAN IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

PO BOX 24584
SEATTLE WA
98124
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3450
  • Fax:
Mailing address:
  • Phone: 425-656-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60131822
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberRS2007-0308
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: