Individual
SCOTT KEITH SULLIVAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1717 SAINT CHARLES AVE, NEW ORLEANS, LA 70130-5223
(504) 899-2800
Mailing address
PO BOX 8664, METAIRIE, LA 70011-8664
(504) 899-2800
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MD.021287
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192322
—
LA
Enumeration date
07/25/2006
Last updated
01/07/2016
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