# DR. JOHN E SULLIVAN JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1124071949
- **Gender:** Man
- **Credential:** M.D

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | ME43835 | FL | Yes |

## Other

- **Enumeration date:** 05/19/2006
- **Last updated:** 04/13/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 051755100 | — | FL |
| 01 | — | 11754 | BCBS | FL |
| 01 | — | 160051136 | MEDICARE RR | FL |
| 01 | — | 203699396 | TAX ID | FL |