Provider Demographics
NPI:1861874703
Name:DROTAR, SULLY (DO)
Entity type:Individual
Prefix:DR
First Name:SULLY
Middle Name:
Last Name:DROTAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 MAPLE AVE APT 714
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2696
Mailing Address - Country:US
Mailing Address - Phone:918-691-6187
Mailing Address - Fax:
Practice Address - Street 1:9101 N CENTRAL EXPY STE 370
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5947
Practice Address - Country:US
Practice Address - Phone:469-820-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-28
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7443207R00000X, 2083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine