Provider Demographics
NPI:1164460945
Name:SULLIVAN, ROBERT SHERWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHERWOOD
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:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-0455
Mailing Address - Country:US
Mailing Address - Phone:865-988-8552
Mailing Address - Fax:865-988-4488
Practice Address - Street 1:198 MORNING POINT DR
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6448
Practice Address - Country:US
Practice Address - Phone:865-675-5490
Practice Address - Fax:865-338-5899
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3094819Medicaid
TN4066102OtherBLUE CROSS/BLUE SHIELD
TN3094819Medicare PIN
TN4066102OtherBLUE CROSS/BLUE SHIELD