Individual
C EUGENE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 W JEFFERSON ST, BOISE, ID 83702-6044
(208) 344-9424
(208) 343-3263
Mailing address
PO BOX 2066, BOISE, ID 83701-2066
(208) 344-9424
(208) 344-3263
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M3232
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0024588
—
ID
Enumeration date
12/10/2007
Last updated
12/10/2007
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