Individual
DR. RANDALL GENE SULLIVAN
Active
Individual
DR. RANDALL GENE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
17415
NE
2084P0800X
Psychiatry Physician
MD2018-0063
NM
2084P0800X
Psychiatry Physician
MD29920
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025598700
—
NE
05
—
47066229013
—
NE
01
—
P00681749
RAILROAD MEDICARE
—
Enumeration date
07/13/2006
Last updated
10/14/2025
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