Individual
DAVID SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2823 GLOVER CARLTON RD, PERRY, FL 32348-7640
(850) 584-4775
(850) 584-4735
Mailing address
2823 GLOVER CARLTON RD, PERRY, FL 32348-7640
(850) 584-4775
(850) 584-4735
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
JB2110
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
690734200
—
FL
Enumeration date
01/08/2014
Last updated
01/09/2014
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