Individual
WILLIAM RYAN SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
227 FALCON DR STE 104, MT STERLING, KY 40353-9792
(859) 497-5160
(859) 497-5166
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7825
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01063074A
IN
208600000X
Surgery Physician
Primary
43004
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000526049
ANTHEM
—
01
—
0816010001
DMERC
—
05
—
200869500A
—
IN
05
—
200869500T
—
IN
05
—
7100089710
—
KY
01
—
P00642704
RAILROAD MEDICARE
—
Enumeration date
06/13/2007
Last updated
07/10/2019
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