Individual
CHARLES D SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
840 N 5TH AVE, STE 2100, SEQUIM, WA 98382-3045
(360) 582-2850
(360) 582-2851
Mailing address
840 N 5TH AVE, STE 2100, SEQUIM, WA 98382-3045
(360) 582-2850
(360) 582-2851
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00019156
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0158209
LABOR & INDUSTRIES
WA
05
—
1819408
—
WA
Enumeration date
05/20/2006
Last updated
08/06/2012
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