Provider Demographics
NPI:1043567316
Name:SULLIVAN, JOANNA GAIL (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:GAIL
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:GAIL
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 HIGH ST
Mailing Address - Street 2:APARTMENT 319
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2450
Mailing Address - Country:US
Mailing Address - Phone:650-561-4301
Mailing Address - Fax:
Practice Address - Street 1:800 HIGH ST
Practice Address - Street 2:APARTMENT 319
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2450
Practice Address - Country:US
Practice Address - Phone:650-561-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG060604207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology