Provider Demographics
NPI:1982612842
Name:SULLIVAN, DENNIS HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:HENRY
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 1:4300 W 7TH ST
Mailing Address - Street 2:GRECC (3J/NLR)
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5446
Mailing Address - Country:US
Mailing Address - Phone:501-257-2503
Mailing Address - Fax:501-257-2501
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:GRECC (3J/NLR)
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-2503
Practice Address - Fax:501-257-2501
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-7225207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J595OtherBCBS
AR16770000000OtherQUALCHOICE
ARN7225OtherTRICARE
ARF94381Medicare UPIN
AR5J595OtherBCBS