Individual
JOSEPH C SULLIVAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11375 CORTEZ BLVD, BROOKSVILLE, FL 34613-5409
(904) 236-5884
(904) 346-4334
Mailing address
PO BOX 116700, ATLANTA, GA 30368-6700
(904) 236-5884
(904) 346-4334
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
052837
GA
2085R0202X
Diagnostic Radiology Physician
24871
AL
2085R0202X
Diagnostic Radiology Physician
54994
TN
2085R0202X
Diagnostic Radiology Physician
Primary
ME160669
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009942658
—
AL
05
—
009942659
—
AL
05
—
009942660
—
AL
05
—
009942662
—
AL
05
—
04923068
—
MS
01
—
051543136
BCBS
AL
01
—
051543137
BCBS
AL
01
—
051543142
BCBS
AL
01
—
051543144
BCBS
AL
05
—
199147922A
—
GA
01
—
P00406959
RR MEDICARE
AL
Enumeration date
10/02/2006
Last updated
03/29/2023
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