Healthcare Provider Details

I. General information

NPI: 1205285244
Provider Name (Legal Business Name): DALE F SUTHERLAND MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18941 JOHN J WILLIAMS HWY
REHOBOTH BEACH DE
19971-4404
US

IV. Provider business mailing address

255 W MICHIGAN AVE PO BOX 1123
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-6992
  • Fax:
Mailing address:
  • Phone: 800-516-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DALE F SUTHERLAND
Title or Position: PRESIDENT
Credential: MD
Phone: 302-381-1087