Healthcare Provider Details

I. General information

NPI: 1235210493
Provider Name (Legal Business Name): DOUGLAS E SUTHERLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 9TH AVE STE 120
LONGVIEW WA
98632-2465
US

IV. Provider business mailing address

3124 S 19TH ST STE 240
TACOMA WA
98405-2433
US

V. Phone/Fax

Practice location:
  • Phone: 360-636-8950
  • Fax: 360-636-8951
Mailing address:
  • Phone: 253-301-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD00048998
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD035545
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: