Individual
DR. ROBERT SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3900 EUBANK BOULEVARD NE, SUITE 9A, ALBUQUERQUE, NM 87111-3465
(505) 286-4492
(505) 286-4392
Mailing address
POST OFFICE BOX 685, TIJERAS, NM 87059-8229
(505) 286-4492
(505) 286-4392
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD2007-0049
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87670780
—
NM
Enumeration date
12/05/2006
Last updated
12/09/2010
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