Provider Demographics
NPI:1902517055
Name:SULLIVAN, JAMES A II (SOIDC, ATP, EMT-P)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:SULLIVAN
Suffix:II
Gender:M
Credentials:SOIDC, ATP, EMT-P
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Other - Last Name:
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Mailing Address - Street 1:3D RECON BAS
Mailing Address - Street 2:UNIT 36180
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96383-6180
Mailing Address - Country:US
Mailing Address - Phone:630-336-0907
Mailing Address - Fax:
Practice Address - Street 1:3D RECON BAS
Practice Address - Street 2:UNIT 36180
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96383-6180
Practice Address - Country:US
Practice Address - Phone:630-336-0907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman