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General NPI Number Information
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NPI Number | 1851531933
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Entity Type | Organization
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Legal Business Name | SULLIVAN MD PLLC
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 5100 E HWY 90 SUITE B
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2443
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Country | US
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Telephone | 520-417-9727
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Fax | 520-417-9733
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Provider Business Mailing Address
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Address Line | 5100 E. HWY. 90 SUITE B
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City | SIERRA VISTA
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State | AZ
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Zip | 85635
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Country | US
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Telephone | 520-417-9727
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Fax | 520-417-9733
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM ROBERT SULLIVAN
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Credential | MD
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Telephone | 520-417-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 22176
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License Number State | AZ
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