Provider Demographics
NPI:1578568010
Name:SULLIVAN, JULIE GAIL (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:GAIL
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 1:1615 S EUCALYPTUS AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6159
Mailing Address - Country:US
Mailing Address - Phone:918-254-6822
Mailing Address - Fax:918-254-6823
Practice Address - Street 1:1615 S EUCALYPTUS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6159
Practice Address - Country:US
Practice Address - Phone:918-254-6822
Practice Address - Fax:918-254-6823
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK238242080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine