Individual
GLEN E SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1625 SE 3RD AVE STE 623, FORT LAUDERDALE, FL 33316-2521
(954) 712-6427
(954) 712-6475
Mailing address
1700 NW 49TH STREET, SUITE 125, FORT LAUDERDALE, FL 33309-3763
(954) 712-6427
(954) 712-6475
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
30881
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037094100
—
FL
Enumeration date
02/02/2006
Last updated
08/08/2019
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