Provider Demographics
NPI:1124071949
Name:SULLIVAN, JOHN E JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:SULLIVAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6304
Mailing Address - Country:US
Mailing Address - Phone:941-955-8076
Mailing Address - Fax:941-955-0453
Practice Address - Street 1:2439 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6304
Practice Address - Country:US
Practice Address - Phone:941-955-8076
Practice Address - Fax:941-955-0453
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43835207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203699396OtherTAX ID
FL11754OtherBCBS
FL160051136OtherMEDICARE RR
FL051755100Medicaid
FL160051136OtherMEDICARE RR
FL11754VMedicare ID - Type Unspecified