Individual
DR. PHILIP SULLIVAN
Active
Individual
DR. PHILIP SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
5348A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790830792
NATIONAL PROVIDER IDENTIFICATION
WY
Enumeration date
01/23/2007
Last updated
08/05/2011
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