Individual
DR. JESSE GEORGE SULLIVAN JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 PARKVIEW DR, EL RENO, OK 73036-2107
(405) 262-2114
(405) 262-2306
Mailing address
1116 MONTREAL DR, YUKON, OK 73099-5349
(405) 354-9769
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
12233
OK
Other
Enumeration date
06/09/2006
Last updated
07/08/2007
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