Individual
MR. KEVIN DOERR SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
208 CEDAR CREEK TER, IONE, WA 99139-5011
(509) 442-3514
Mailing address
208 CEDAR CREEK TER, IONE, WA 99139-5011
(509) 442-3514
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60716898
WA
363A00000X
Physician Assistant
TA60724212
WA
Other
Enumeration date
01/05/2017
Last updated
02/24/2017
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