Provider Demographics
NPI:1205198561
Name:SULLIVAN, RACHAEL ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1105 W FRANK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3303
Mailing Address - Country:US
Mailing Address - Phone:936-631-6771
Mailing Address - Fax:936-639-8952
Practice Address - Street 1:1105 W FRANK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3303
Practice Address - Country:US
Practice Address - Phone:936-634-8111
Practice Address - Fax:936-639-8952
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ8363207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology