Provider Demographics
NPI:1679193767
Name:SULLIVAN, REBECCA CRAIN (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CRAIN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LILLIAN
Other - Last Name:CRAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0764
Mailing Address - Country:US
Mailing Address - Phone:409-772-0122
Mailing Address - Fax:409-747-0777
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1900
Practice Address - Country:US
Practice Address - Phone:094-772-0122
Practice Address - Fax:409-747-0777
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXBP10084453207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program