Individual
DAVID WAYNE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6029 WALNUT GROVE RD STE 301, MEMPHIS, TN 38120-2112
(901) 747-9081
(901) 747-9087
Mailing address
965 RIDGE LAKE BLVD STE 103, MEMPHIS, TN 38120-9446
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
11785
MS
207RH0003X
Hematology & Oncology Physician
20920
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125865
—
MS
01
—
P00272099
RAILROAD MEDIARE
MS
Enumeration date
07/14/2005
Last updated
06/23/2021
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