Individual
MR. JOACHIM ANDREW SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0002
(254) 724-4071
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M5947
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M5947
LICENSE#
TX
Enumeration date
08/21/2007
Last updated
11/06/2020
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