Basic Information
| Provider Information | |||||||||
| NPI: | 1992775837 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | ANTHONY | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1650 COCHRANE CIRCLE, ATTN: CREDENTIALS OFFICE | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267844 | ||||||||
| FaxNumber: | 7195267984 | ||||||||
| Practice Location | |||||||||
| Address1: | USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1650 COCHRANE CIRCLE, DEPT OF OB/GYN | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267406 | ||||||||
| FaxNumber: | 7195267850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 43116 | CO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.