Individual
DANIEL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-4673
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
ME43161
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26886
BLUE CROSS BLUE SHIELD
FL
05
—
377596800
—
FL
Enumeration date
08/01/2006
Last updated
06/02/2008
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