Provider Demographics
NPI:1588671895
Name:SULLIVAN, MURRAY GLENN III (MD)
Entity type:Individual
Prefix:
First Name:MURRAY
Middle Name:GLENN
Last Name:SULLIVAN
Suffix:III
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 1:145 W WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1239
Mailing Address - Country:US
Mailing Address - Phone:419-423-5262
Mailing Address - Fax:419-423-5550
Practice Address - Street 1:139 GARAU ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1027
Practice Address - Country:US
Practice Address - Phone:419-358-9010
Practice Address - Fax:419-358-1189
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064725207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2342594Medicaid
F60549Medicare UPIN