Provider Demographics
NPI:1992890701
Name:SUTHERLAND JR, HAROLD PRATT JR (MD)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:PRATT
Last Name:SUTHERLAND JR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:8TH AVENUE AND C STREET
Practice Address - Street 2:LSC HOSPITAL
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT159451-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001204600Medicaid
UT35935OtherDESERET MUTUAL
UTQM0000075886OtherALTIUS
UT2090168OtherUNITED HEALTHCARE
UT37825OtherPEHP
UT8597445OtherUMWA
UT870545614SU1OtherEDUCATORS MUTUAL
NV002084033Medicaid
UT1502954OtherUMWA
UTPRA02504OtherMOLINA
UT107006361101OtherIHC
WY107983200Medicaid
AZ820937Medicaid
UT53275OtherHEALTHY U
UTD20443Medicare UPIN
UT050044244Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AZ820937Medicaid