Individual
DR. MATTHEW SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104
(817) 702-8773
Mailing address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
Q7799
TX
Other
Enumeration date
06/14/2014
Last updated
06/22/2018
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