Individual
GUY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
450 LAUREL ST, SUITE A, DES MOINES, IA 50314-3045
(515) 247-8400
(515) 248-8888
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
084075
IA
363A00000X
Physician Assistant
1377
SD
363AS0400X
Surgical Physician Assistant
084075
IA
Other
Enumeration date
07/05/2016
Last updated
07/07/2023
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