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Contact Information

TIMOTHY J SULLIVAN III, MD
4403 HARRISON BLVD.
STE 4640
OGDEN, UT84403-3304
 Phone: 801-387-4850
 Fax: 801-387-4855
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Allergy

207KA0200X 03 Physician/Allergy/ Immunology
Indicates primary specialty

NPI Profile & details for TIMOTHY J SULLIVAN III · (Male)

NPI Number 1023012911
Status Active
Credentials MD
Entity Individual
Enumeration date 06/08/2005
Last updated 06/03/2015 - About 11 years ago
Sole proprietor 1 Yes
Identifiers
  • GA License # 037913
  • UT License # 8263858-1205
  • GA Medicaid 00570996C
  • GA Medicaid 00570996F
Hospital affiliation(s)
  • MCKAY DEE HOSPITAL CENTER - (Acute Care)
    4401 HARRISON BOULEVARD
    OGDEN, UT 84403
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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