Individual
SCOTT G SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
408 W 19TH ST, PANAMA CITY, FL 32405-4602
(850) 481-1101
Mailing address
408 W 19TH ST, PANAMA CITY, FL 32405-4602
(850) 481-1101
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9110596
FL
Other
Enumeration date
12/06/2006
Last updated
07/15/2023
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