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General NPI Number Information
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NPI Number | 1881749224
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Entity Type | Individual
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Provider Name | SEAN K. OSULLIVAN M.D., D.A.B.R.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 6915 N. MAIN ST.
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City | VICTORIA
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State | TX
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Zip | 77904
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Country | US
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Telephone | 361-572-3139
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Fax | 361-572-8610
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Provider Business Mailing Address
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Address Line | 6915 N. MAIN ST.
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City | VICTORIA
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State | TX
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Zip | 77904
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Country | US
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Telephone | 361-572-3139
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Fax | 361-572-8610
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | H6481
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License Number State | TX
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