Glen O'Sullivan, M.D

NPI 1972504652 · on the registry since 2005 · sole proprietor

Practice

Address: 635 Lassen Ln
Mount Shasta, CA 96067
Phone: (866) 668-3597
Fax: (866) 301-6641
Organisation at this address: Peter Grant Md
Julie Conyers Md Inc
Todd Guthrie, M.D., Professional Corporation
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 2

Registry record

Primary taxonomy: 174400000X
174400000X
Licence states on file: CA
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2010-11-23

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California