Provider Demographics
NPI:1194839068
Name:SUNDERLAND, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:SUNDERLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 W DESCHUTES AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7807
Mailing Address - Country:US
Mailing Address - Phone:509-374-4030
Mailing Address - Fax:509-374-8690
Practice Address - Street 1:7221 W DESCHUTES AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7807
Practice Address - Country:US
Practice Address - Phone:509-374-4030
Practice Address - Fax:509-374-4030
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000467242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7823107Medicaid
WA7823107Medicaid
8860964Medicare PIN