Healthcare Provider Details

I. General information

NPI: 1932387198
Provider Name (Legal Business Name): JOHN BARTLETT SUTHERLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E FOREMASTER DR SUITE 200
ST GEORGE UT
84790-4488
US

IV. Provider business mailing address

1490 E FOREMASTER DR SUITE 200
ST GEORGE UT
84790-4488
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-1641
  • Fax: 435-628-1660
Mailing address:
  • Phone: 435-628-1641
  • Fax: 435-628-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7675946-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number76759461205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: