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General NPI Number Information
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NPI Number | 1396795480
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Entity Type | Individual
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Provider Name | PETER M. SUTHERLAND MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 420 W MORRIS BLVD HEALTHSTAR PHYSICIANS STE 400B
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City | MORRISTOWN
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State | TN
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Zip | 37813
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Country | US
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Telephone | 423-586-2410
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Fax | 423-581-9692
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Provider Business Mailing Address
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Address Line | 420 W MORRIS BLVD HEALTHSTAR PHYSICIANS STE 400B
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City | MORRISTOWN
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State | TN
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Zip | 37813
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Country | US
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Telephone | 423-586-2410
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Fax | 423-581-9692
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD27528
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License Number State | TN
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