Individual
DR. PHILIP SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
831 STATE HIGHWAY 150 S, EVANSTON, WY 82930-5340
(307) 789-3464
(307) 789-7373
Mailing address
PO BOX 177, EVANSTON, WY 82931-0177
(307) 789-3464
(307) 789-7373
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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