Provider Demographics
NPI:1013987635
Name:SULLIVAN, HAROLD HAYES JR (MD, MPH)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:HAYES
Last Name:SULLIVAN
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ZEAGLER DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6806
Mailing Address - Country:US
Mailing Address - Phone:386-328-4242
Mailing Address - Fax:386-328-4244
Practice Address - Street 1:700 ZEAGLER DR
Practice Address - Street 2:SUITE 8
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6806
Practice Address - Country:US
Practice Address - Phone:386-328-4242
Practice Address - Fax:386-328-4244
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106620207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004179900Medicaid
FL004179900Medicaid
MEDC0798OtherRAILROAD MEDICARE
ME126510099Medicaid