Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 35.060447 | OH |
NPI | 1053340372 |
---|---|
Provider Name | Dr. John Joseph Sullivan |
First Address | Cincinnati, OH 45212-3359 |
Second Address | Cincinnati, OH 45249-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 22/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09714269030 | (05) | OH |
F60590 | (02) | OH |