Individual
TERRY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11671 BACA RD, CONIFER, CO 80433-7522
(720) 331-8553
Mailing address
11671 BACA RD, CONIFER, CO 80433-7522
(720) 331-8553
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22560
CO
Other
Enumeration date
01/20/2011
Last updated
01/20/2011
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