Organization · Type 2 NPI
Sullivan Medical Clinic
Adolescent Medicine (Family Medicine) Physician · Sullivan, TX
NPI number
1205919214
Active
Practice location
11325 W Expressway 83
Sullivan, TX 78595
Fax (956) 485-0107
Mailing address
PO Box 250
Sullivan City, TX 78595-0250
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adolescent Medicine (Family Medicine) Physician Primary | 207QA0000X | None listed |
| Adult Medicine Physician | 207QA0505X | None listed |
Adolescent Medicine (Family Medicine) Physician: A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.
About NPI 1205919214
Sullivan Medical Clinic's National Provider Identifier is 1205919214, issued on Oct 23, 2006. The primary taxonomy on file is Adolescent Medicine (Family Medicine) Physician (207QA0000X), and the practice location is in Sullivan, TX. The record was last updated on Sep 25, 2007.