Healthcare Provider Details

I. General information

NPI: 1851232722
Provider Name (Legal Business Name): GLEN E SUTHERLAND MD FACP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S UNIVERSITY DR STE 106
PLANTATION FL
33324-3345
US

IV. Provider business mailing address

6075 NW 96TH DR
PARKLAND FL
33076-1845
US

V. Phone/Fax

Practice location:
  • Phone: 954-803-5906
  • Fax:
Mailing address:
  • Phone: 954-803-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GLEN SUTHERLAND
Title or Position: PRESIDENT
Credential: MD
Phone: 954-803-5906