Healthcare Provider Details

I. General information

NPI: 1447251848
Provider Name (Legal Business Name): JOHN SUTHERLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 N 7TH ST SUITE 7
PHOENIX AZ
85020-1763
US

IV. Provider business mailing address

9812 N 7TH ST SUITE 7
PHOENIX AZ
85020-1763
US

V. Phone/Fax

Practice location:
  • Phone: 602-714-6783
  • Fax:
Mailing address:
  • Phone: 602-714-6783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number27081
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27081
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number27081
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: