Individual
RAYMOND JAMES SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 MEDICAL VILLAGE DR, INDEPENDENT ANESTHESIOLOGISTS. PSC, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DR, STE 258, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
26391
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000032585
ANTHEM BLUE SHIELD
—
05
—
0959173
—
OH
05
—
64263916
—
KY
Enumeration date
12/13/2005
Last updated
02/20/2008
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