# SCOT A SULLIVAN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831610641
- **Authorized official:** DR. SCOT SULLIVAN MD (OWNER)
- **Authorized official phone:** (503) 841-7593

## Contact information

- **Practice address:** 2020 E 15TH ST STE B, EDMOND, OK 73013-6749
- **Practice address phone:** (405) 348-9993
- **Mailing address:** 1025 NW COUCH ST UNIT 819, PORTLAND, OR 97209-4132
- **Mailing address phone:** (503) 841-7593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 20157 | OK | Yes |

## Other

- **Enumeration date:** 06/30/2017
- **Last updated:** 06/30/2017