Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 12047 | TX |
NPI | 1811254402 |
---|---|
Provider Name | Dr. Dan Jason Sullins |
First Address | Dallas, TX 75248-1141 |
Second Address | Dallas, TX 75248-1141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 17/09/2012 |