Sullivan, Brent C

Sullivan, Brent C is an individual health care provider with primary practice located at 14547 Bruce B Downs Blvd Suite D, Tampa FL 33613. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Sullivan, Brent C can be contacted via phone (813) 979-7733.

Contact Information

Primary practice address
14547 Bruce B Downs Blvd Suite D Tampa FL 33613
Phone: (813) 979-7733
Fax: (813) 355-5098
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X ME69655 Florida

Profile Details

NPI number 1710098173
LBN Legal business name Sullivan, Brent C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Aug 27th, 2021 - about 3 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 1710098173 NPPES
Florida MEDICAID 269015200
Florida Other P00085921

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