Sullivan, Fred M

Sullivan, Fred M is an individual health care provider with primary practice located at 1501 Kings Hwy , Shreveport LA 71103-4228. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Sullivan, Fred M can be contacted via phone (318) 675-5000.

Contact Information

Primary practice address
1501 Kings Hwy Shreveport LA 71103-4228
Phone: (318) 675-5000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 016881 Louisiana
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 016881 Louisiana

Profile Details

NPI number 1841396611
LBN Legal business name Sullivan, Fred M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 16th, 2006
Last updated May 15th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841396611 NPPES
Louisiana MEDICAID 1345261
Louisiana Other 5M257F600

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