MEDICARE: DR. JAMES M. SUTHERLAND DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0127X	Trauma Surgery Physician	OS8951	FL
2	2086S0129X	Vascular Surgery Physician	OS8951	FL
3	208600000X	Surgery Physician	OS8951	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811982945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M. SUTHERLAND DO

Provider Business Mailing Address
First Line	:	1061 MEDICAL CENTER DR
Second Line	:	SUITE 310
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8200
Country	:	US
Telephone Number	:	386-917-7620
Fax Number	:	386-917-7621

Provider Business Practice Location Address
First Line	:	1061 MEDICAL CENTER DR STE 102
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8225
Country	:	US
Telephone Number	:	386-917-7620
Fax Number	:	386-917-7621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	10/10/2019

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