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Individual
DR. GARRETT GRAY SULLIVAN
Active
Individual
DR. GARRETT GRAY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-33297
KS
207QA0401X
Addiction Medicine (Family Medicine) Physician
2014012167
MO
208D00000X
General Practice Physician
04-33297
KS
Other
Enumeration date
03/30/2007
Last updated
03/04/2016
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