Sullivan, C Eugene

Sullivan, C Eugene is an sole proprietor health care provider with primary practice located at 210 W Jefferson St , Boise ID 83702-6044. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Sullivan, C Eugene can be contacted via phone (208) 344-9424.

Contact Information

Primary practice address
210 W Jefferson St Boise ID 83702-6044
Fax: (208) 343-3263
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X M3232 Idaho

Profile Details

NPI number 1649453903
LBN Legal business name Sullivan, C Eugene
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 10th, 2007
Last updated Dec 10th, 2007 - about 18 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 1649453903 NPPES
Idaho MEDICAID 0024588

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