Individual
BRIAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2419 ALONZO ST, ABBEVILLE, LA 70510-4008
(337) 892-0630
(337) 893-0403
Mailing address
PO BOX 1158, ABBEVILLE, LA 70511-1158
(337) 892-0630
(337) 893-0403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
025122
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1422177
—
LA
01
—
561696907C
BLUE CROSS
LA
01
—
P00316386
RAILROAD MEDICARE
—
Enumeration date
06/12/2006
Last updated
03/19/2008
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