Individual
BRENT C SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14547 BRUCE B DOWNS BLVD, SUITE D, TAMPA, FL 33613
(813) 979-7733
(813) 355-5098
Mailing address
38135 MARKET SQUARE, ZEPHYRHILLS, FL 33542
(813) 528-4975
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME69655
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269015200
—
FL
01
—
P00085921
RR MEDICARE
FL
Enumeration date
08/31/2006
Last updated
08/27/2021
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