Healthcare Provider Details

I. General information

NPI: 1144292384
Provider Name (Legal Business Name): GLEN E SUTHERLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S UNIVERSITY DR STE 106
PLANTATION FL
33324
US

IV. Provider business mailing address

6075 NW 96 DR
PARKLAND FL
33076
US

V. Phone/Fax

Practice location:
  • Phone: 954-703-9900
  • Fax: 954-712-6475
Mailing address:
  • Phone: 954-703-9900
  • Fax: 954-712-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number30881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: