Glen S O'Sullivan, M.D.
Specialist in Mount Shasta, CA. Individual provider (NPI-1).
NPI number1972504652
StatusActive
Last updated in NPPESNov 23, 2010
Details
- NPI
- 1972504652
- Entity type
- Individual (NPI-1)
- Name
- Glen S O'Sullivan
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 3, 2005
- Last updated
- Nov 23, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | A44219 | CA | Yes |
Practice location
635 Lassen LnMount Shasta, CA 96067-9003
Phone 866-668-3597 · Fax 866-301-6641
Mailing address
635 Lassen LnMount Shasta, CA 96067-9003
Phone 866-668-3597 · Fax 866-301-6641
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