| Doctor Name: | DR. TIMOTHY JOHN SULLIVAN |
| NPI Number: | 1023012911 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 037913 |
| Business Practice Address: | 4403 Harrison Blvd. Ste 4640 Ogden, UT - 844033304 |
| Business Phone Number: | 8013874850 |
| Business Fax Number: | 8013874855 |
| Mailing Address: | 4403 Harrison Blvd., Ste 4640 OGDEN |
| State: | UT |
| Postal Code: | 844033304 |
| Phone Number: | 8013874850 |
| Fax Number: | 8013874855 |
| NPI Enumeration Date: | 06/08/2005 |
| NPI Last Update Date: | 06/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207KA0200X |
| License Number: | 037913 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Allergy & Immunology |
| Taxonomy Specialization: | Allergy |
| Taxonomy Definition: | |