Provider Demographics
NPI:1609824051
Name:SUTHERLAND, ANNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SW 257TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-1900
Mailing Address - Country:US
Mailing Address - Phone:503-669-6800
Mailing Address - Fax:503-491-1352
Practice Address - Street 1:1700 SW 257TH AVE
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-1900
Practice Address - Country:US
Practice Address - Phone:503-669-6800
Practice Address - Fax:503-491-2434
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287558Medicaid
911768081OtherUNITED HEALTHCARE
069013001OtherBLUE CROSS/BLUE SHIELD
150756OtherWA LABOR & INDUSTRY
911768081OtherHEALTHNET
OR3004113-13OtherBLUE CROSS HMO
ORODSOther911768081
7590294OtherAETNA
OR3004113-13OtherBLUE CROSS HMO
911768081OtherHEALTHNET
ORR109835Medicare PIN