Sullivan, Bryan Tipton

Sullivan, Bryan Tipton is an individual health care provider with primary practice located at 1915 Dunbarton Drive , Jackson MS 39216. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Sullivan, Bryan Tipton can be contacted via phone (601) 982-3338.

Contact Information

Primary practice address
1915 Dunbarton Drive Jackson MS 39216
Phone: (601) 982-3338
Fax: (601) 982-2253
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 80089 Mississippi

Profile Details

NPI number 1164592044
LBN Legal business name Sullivan, Bryan Tipton
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 8th, 2006
Last updated Jun 5th, 2008 - 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 1164592044 NPPES
Mississippi MEDICAID 00012910
Mississippi Other 480007636

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