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General NPI Number Information
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NPI Number | 1982159166
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Entity Type | Organization
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Legal Business Name | JESSE O. SUTHERLAND JR., M.D.
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 2200 S FEDERAL BLVD SUITE 4
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City | DENVER
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State | CO
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Zip | 80219-5444
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Country | US
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Telephone | 303-934-4862
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Fax | 303-937-7160
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Provider Business Mailing Address
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Address Line | 2200 S FEDERAL BLVD SUITE 4
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City | DENVER
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State | CO
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Zip | 80219-5444
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Country | US
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Telephone | 303-934-4862
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Fax | 303-937-7160
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JESSE O. SUTHERLAND JR.
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Credential | M.D.
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Telephone | 303-934-4862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 22563
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License Number State | CO
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