Scott G Sullivan PA

NPI 1750440004 - Physician Assistant - 363A00000X

NPI Details
NPI 1750440004
Gender Male
Enumeration Date 12/06/2006
Last Updated 09/21/2009
Entity Type Individual
Active Over 10 years ago
Practice Location
301 ANDREWS AVENUE
(LYSTER ARMY HEALTH CLINIC)
FORT RUCKER AL, 36362-5000, US
Phone (334) 255-7097
Fax
Business Location
1901 MCGINNIS CT
HARKER HEIGHTS TX, 76548-8034, US
Phone (254) 698-2499
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Texas
License Number PA04814
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According to our database, Scott G Sullivan PA NPI is 1750440004, taxonomy code is 363A00000X and license number is PA04814, license state is located at Texas. Scott G Sullivan PA physically located at 301 Andrews Avenue, Fort Rucker AL, 36362-5000. NPI Number Scott G Sullivan PA has the Individual type.

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1750440004 NPI number is provided on an as is basis without warranty of any kind. 1750440004 is maintained by the National Plan & Provider Enumeration System. The contents of Scott G Sullivan PA are for informational purposes only.