Individual
DR. KEVIN JEREMIAH SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4700 POINT FOSDICK DR NW, STE 202, GIG HARBOR, WA 98335-1706
(253) 858-9192
(253) 857-1489
Mailing address
4700 POINT FOSDICK DR NW, STE 202, GIG HARBOR, WA 98335-1706
(253) 858-9192
(253) 857-1489
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00037591
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131075
STATE L&I
WA
01
—
080144712
RAILROAD
WA
05
—
8243149
—
WA
01
—
8928703
STATE CRIME VICTIMS
WA
Enumeration date
07/11/2006
Last updated
11/16/2010
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