Provider Demographics
NPI:1518943349
Name:SULLIVAN, BARBARA M (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 101500
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-9500
Mailing Address - Country:US
Mailing Address - Phone:210-733-4400
Mailing Address - Fax:210-733-4401
Practice Address - Street 1:2829 BABCOCK RD
Practice Address - Street 2:STE 215
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201
Practice Address - Country:US
Practice Address - Phone:210-733-4400
Practice Address - Fax:210-733-4401
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF45762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10963Medicare UPIN
TX081R624Medicare ID - Type Unspecified