Dr. Fred Richard Sullivan JR.
Hematologist
3181 Sw Sam Jackson Park Rd
Portland
, Oregon 97239-3011
Dr. Fred Richard Sullivan JR.
Hematologist
3181 Sw Sam Jackson Park Rd
Portland
, Oregon 97239-3011
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About
Features
Specialties
- Hematologist
Languages spoken
- English
Location
First Address
- Dr. Fred Richard Sullivan JR.
- 3181 Sw Sam Jackson Park Rd
- Portland, OR
- Zip : 97239-3011
- Phone :
Second Address
- Dr. Fred Richard Sullivan JR.
- 3181 Sw Sam Jackson Park Rd
- Portland, OR
- Zip : 97239-3011
- Phone : (503) 494-6594
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RH0000X | Hematologist | MD24620 | OR |
National Provider Identifier
| NPI | 1306852801 |
|---|---|
| Provider Name | Dr. Fred Richard Sullivan JR. |
| First Address | Portland, OR 97239-3011 |
| Second Address | Portland, OR 97239-3011 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/08/2006 |
| Last Update Date | 16/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 227500 | (05) | OR |
| D83043 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.