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General NPI Number Information
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NPI Number | 1295939262
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Entity Type | Individual
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Provider Name | CLYDE SULLIVAN II M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 7850 COLLIN MCKINNEY PKWY SUITE 120
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City | MCKINNEY
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State | TX
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Zip | 75070-2140
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Country | US
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Telephone | 469-854-8920
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Fax | 469-854-8923
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Provider Business Mailing Address
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Address Line | 7850 COLLIN MCKINNEY PKWY SUITE 120
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City | MCKINNEY
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State | TX
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Zip | 75070-2140
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Country | US
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Telephone | 469-854-8920
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Fax | 469-854-8923
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2866626-S150
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | N6695
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License Number State | TX
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