Individual
JERRY WARNER SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 N JEFFERSON DAVIS PKWY, 1ST FLOOR, NEW ORLEANS, LA 70119-5311
(504) 412-1600
Mailing address
1340 POYDRAS ST, NEW ORLEANS, LA 70112-1221
(504) 412-1860
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
03107R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1171140
—
LA
Enumeration date
07/25/2006
Last updated
07/08/2007
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