Provider Demographics
NPI:1811982945
Name:SUTHERLAND, JAMES M (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1061 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8200
Mailing Address - Country:US
Mailing Address - Phone:386-917-7620
Mailing Address - Fax:386-917-7621
Practice Address - Street 1:1061 MEDICAL CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8225
Practice Address - Country:US
Practice Address - Phone:386-917-7620
Practice Address - Fax:386-917-7621
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS89512086S0127X, 2086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267216200Medicaid
FL267216200Medicaid
FLG25507Medicare UPIN