Individual
DR. DANIEL JOSEPH SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1739 BEVERLY AVE, SUITE 107, KINGMAN, AZ 86409-3593
(928) 681-8565
(928) 681-8564
Mailing address
1739 BEVERLY AVE, SUITE 107, KINGMAN, AZ 86409-3593
(928) 681-8565
(928) 681-8564
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
35063476S
OH
207XS0117X
Orthopaedic Surgery of the Spine Physician
38140
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
321301
—
AZ
Enumeration date
07/20/2005
Last updated
10/06/2008
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