Sullivan, Timothy John

Sullivan, Timothy John is an sole proprietor health care provider with primary practice located at 4403 Harrison Blvd. Ste 4640, Ogden UT 84403-3304. He recently has only one registered license in Allopathic & Osteopathic Physicians / Allergy, which is considered as his primary health care specialty. Sullivan, Timothy John can be contacted via phone (801) 387-4850.

Contact Information

Primary practice address
4403 Harrison Blvd. Ste 4640 Ogden UT 84403-3304
Phone: (801) 387-4850
Fax: (801) 387-4855
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy 207KA0200X 037913 Georgia
Allopathic & Osteopathic Physicians / Allergy 207KA0200X 8263858-1205 Utah

Profile Details

NPI number 1023012911
LBN Legal business name Sullivan, Timothy John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 8th, 2005
Last updated Jun 3rd, 2015 - about 10 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 1023012911 NPPES
Georgia MEDICAID 00570996C
Georgia MEDICAID 00570996F

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