Provider Demographics
NPI:1295926483
Name:SULLIVAN, RONALD DAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DAYTON
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 MONROE DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2114
Mailing Address - Country:US
Mailing Address - Phone:903-838-4816
Mailing Address - Fax:
Practice Address - Street 1:2300 MARIE CURIE BLVD.
Practice Address - Street 2:BAYLOR MEDICAL CENTER AT GARLAND
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042
Practice Address - Country:US
Practice Address - Phone:817-727-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN33362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
879930768OtherMYUTMB 879930768
TX204266501Medicaid
TX204266501Medicaid