Individual
DR. JOHN ROBERT SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 W MORENO ST, PENSACOLA, FL 32501-2316
(850) 469-7406
Mailing address
PO BOX 17567, PENSACOLA, FL 32522-7567
(850) 469-7406
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
ME89561
FL
208M00000X
Hospitalist Physician
ME89561
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009934587
—
AL
05
—
1495727
—
LA
05
—
274463500
—
FL
01
—
30178
BLUE CROSS BLUE SHIELD
FL
01
—
59183344
BLUE CROSS BLUE SHIELD
AL
01
—
7161237
AETNA
—
01
—
P00293340
MEDICARE RAILROAD
FL
Enumeration date
08/03/2005
Last updated
04/29/2021
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