Individual
JOHN A. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R6F03
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110826001
—
AR
01
—
1256
BLUE
MO
05
—
202340501
—
MO
01
—
300034332
RRR MEDICARE
MO
Enumeration date
03/14/2006
Last updated
09/10/2009
Update your record
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