Sullivan, John A.

Sullivan, John A. is an individual health care provider with primary practice located at 7330 Ryegrass Road , Jackson WY 83001. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Sullivan, John A. can be contacted via phone (307) 733-9105.

Contact Information

Primary practice address
7330 Ryegrass Road Jackson WY 83001
Phone: (307) 733-9105
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X R6F03 Missouri

Profile Details

NPI number 1013985134
LBN Legal business name Sullivan, John A.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Sep 10th, 2009 - about 17 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 1013985134 NPPES
Missouri Other 1256 BLUE
Missouri MEDICAID 202340501 BLUE
Missouri MEDICAID 110826001 BLUE
Missouri Other 300034332 BLUE

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