Organization
GLEN E SUTHERLAND MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN EDWARD SUTHERLAND M.D. (PHYSICIAN)
(954) 772-6781
Entity
Organization
Contact information
Practice address
1930 NE 47TH ST, SUITE 301, FORT LAUDERDALE, FL 33308-7718
(954) 772-6781
(954) 772-6793
Mailing address
1930 NE 47TH ST, SUITE 301, FORT LAUDERDALE, FL 33308-7718
(954) 772-6781
(954) 772-6793
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
12/22/2006
Last updated
08/21/2009
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