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Contact Information

BRYAN T SULLIVAN, DPM
1915 DUNBARTON DRIVE
JACKSON, MS39216
 Phone: 601-982-3338
 Fax: 601-982-2253
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for BRYAN T SULLIVAN · (Male)

NPI # 1164592044
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 11/08/2006
Last updated 06/05/2008 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • MS License # 80089
  • MS Medicaid 00012910
  • Other 480007636 RAILROAD MEDICARE
Hospital affiliation(s)
  • MISSISSIPPI BAPTIST MEDICAL CENTER - (Acute Care)
    1225 N STATE ST
    JACKSON, MS 39202
  • ST DOMINIC-JACKSON MEMORIAL HOSPITAL - (Acute Care)
    969 LAKELAND DR
    JACKSON, MS 39216
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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