Provider Demographics
NPI:1245291772
Name:SUTHERLIN, RALPH MARC (DO)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MARC
Last Name:SUTHERLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:622 W COLLEGE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-1822
Mailing Address - Country:US
Mailing Address - Phone:208-568-7800
Mailing Address - Fax:208-685-7801
Practice Address - Street 1:622 W COLLEGE AVE STE 2
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1822
Practice Address - Country:US
Practice Address - Phone:208-568-7800
Practice Address - Fax:208-568-7801
Is Sole Proprietor?:No
Enumeration Date:2006-04-02
Last Update Date:2024-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDO-2642083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine