Individual
CARY PATRICK SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
128 W MAIN, VIAN, OK 74962-0446
(918) 773-5228
(918) 289-2678
Mailing address
PO BOX 446, VIAN, OK 74962-0446
(918) 773-5228
(918) 773-8482
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2148
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100254810E
—
OK
05
—
100254810G
—
OK
01
—
731153208003
BLUE CROSS BLUE SHIELD
OK
Enumeration date
05/25/2006
Last updated
04/23/2026
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