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General NPI Number Information
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NPI Number | 1326102252
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Entity Type | Organization
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Legal Business Name | GLEN E SUTHERLAND MD PA
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 1930 NE 47TH ST SUITE 301
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-7718
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Country | US
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Telephone | 954-772-6781
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Fax | 954-772-6793
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Provider Business Mailing Address
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Address Line | 1930 NE 47TH ST SUITE 301
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-7718
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Country | US
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Telephone | 954-772-6781
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Fax | 954-772-6793
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GLEN EDWARD SUTHERLAND
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Credential | M.D.
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Telephone | 954-772-6781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 30881
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License Number State | FL
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