Provider Demographics
NPI:1114187317
Name:SUTHERLAND, COURTNEY SIEMS (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SIEMS
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:E
Other - Last Name:SIEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11511 SHADOW CREEK PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:560 MEYERLAND PLAZA MALL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1615
Practice Address - Country:US
Practice Address - Phone:713-442-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194448001Medicaid
TX194448002Medicaid
TX194448001Medicaid
TXH54E - 8K9080Medicare PIN
TX872T - 8K9078Medicare PIN