Provider Demographics
NPI:1619977345
Name:SULLIVAN, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:SULLIVAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7740 POINT MEADOWS DR
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9179
Mailing Address - Country:US
Mailing Address - Phone:904-527-3577
Mailing Address - Fax:904-527-3514
Practice Address - Street 1:7740 POINT MEADOWS DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9179
Practice Address - Country:US
Practice Address - Phone:904-527-3577
Practice Address - Fax:904-527-3514
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2017-04-05
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Provider Licenses
StateLicense IDTaxonomies
FLME0064370207W00000X
FLME64370207WX0107X
GA37090207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373365300Medicaid
GA00578113AMedicaid
GA00578113AMedicaid
F33855Medicare UPIN
FL188772Medicare ID - Type Unspecified