Provider Demographics
NPI:1447477583
Name:SULLIVAN, PHILIP J (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:SULLIVAN
Suffix:
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 1:3124 S CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-6808
Mailing Address - Country:US
Mailing Address - Phone:303-692-9755
Mailing Address - Fax:
Practice Address - Street 1:191 E ORCHARD RD
Practice Address - Street 2:STE 102NE
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80121-8000
Practice Address - Country:US
Practice Address - Phone:303-730-1313
Practice Address - Fax:303-730-2090
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19503207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine