Active NPI
Raymond Lawrence Sullivan Jr., MD
- Anesthesiology Physician
- San Jose, CA
National Provider Identifier
1780630111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- A23094
- Practice address
- 2105 Forest Ave
San Jose, CA 95128-1425 - Phone
- (408) 947-2500
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | A23094 | CA | Primary |
Addresses
Primary practice location
2105 Forest Ave
San Jose, CA 95128-1425
Mailing address
PO Box 34940
Seattle, WA 98124-1940
Phone (503) 372-2740
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A230940 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A23094 | CA | MD | Anesthesiology Physician |
| 23094 | CA | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208476800000",
"number": "1780630111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 34940",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981241940",
"telephone_number": "503-372-2740",
"fax_number": "503-372-2754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2105 FOREST AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951281425",
"telephone_number": "408-947-2500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "RAYMOND",
"middle_name": "LAWRENCE",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2008-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "A23094",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A230940",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.