Individual
EDWARD M SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
341 WHEATFIELD DR, SUITE 190, SUNNYVALE, TX 75182-4638
(972) 686-8200
(972) 686-7711
Mailing address
3209 WILLOW BND, BEDFORD, TX 76021-3836
(972) 686-8200
(972) 686-7711
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01111
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013069541
—
TX
Enumeration date
07/18/2005
Last updated
09/17/2010
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