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Individual

BRIAN L SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2500 W WILLIAM CANNON DR, STE 401, AUSTIN, TX 78745-5257
(512) 451-1969
Mailing address
PO BOX 52194, DEPARTMENT 959, PHOENIX, AZ 85072-2194
(512) 451-1969

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
E1946
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
132982303
TX
Enumeration date
12/02/2005
Last updated
10/25/2010
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