Sullivan, Spencer K
Sullivan, Spencer K is an individual health care provider with primary practice located at 7730 Old Canton Rd Bldg B , Madison MS 39110-9299. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology, which is considered as his primary health care specialty. Sullivan, Spencer K can be contacted via phone (601) 499-0935.Contact Information
Primary practice address
7730 Old Canton Rd Bldg B
Madison MS 39110-9299
Phone: (601) 499-0935
Fax: (601) 499-0936
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology | 2080P0207X | 23304 | Mississippi |
Profile Details
| NPI number | 1073735114 |
|---|---|
| LBN Legal business name | Sullivan, Spencer K |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 2nd, 2007 |
| Last updated | Apr 30th, 2024 - about last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073735114 | NPPES |
| Mississippi | MEDICAID | 01212067 |
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