Individual
CLARENCE MICHAEL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 916-3918
Mailing address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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