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General NPI Number Information
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NPI Number | 1710095567
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Entity Type | Organization
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Legal Business Name | FLORIDA ADVANCED PULMONARY PA
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 2801 SW COLLEGE ROAD SUITE 16
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City | OCALA
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State | FL
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Zip | 34474-4447
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Country | US
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Telephone | 352-873-0508
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Fax | 352-861-0260
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Provider Business Mailing Address
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Address Line | 2801 SW COLLEGE ROAD SUITE 16
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City | OCALA
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State | FL
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Zip | 34474
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Country | US
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Telephone | 352-873-0508
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Fax | 352-861-0260
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHRISTOPHER J SULLIVAN
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Credential | MD
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Telephone | 352-873-0508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | ME0063329
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME0063329
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License Number State | FL
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