1609824051 NPI number — DR. ANNE M SUTHERLAND M.D.

Table of content: DR. ANNE M SUTHERLAND M.D. (NPI 1609824051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609824051 NPI number — DR. ANNE M SUTHERLAND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTHERLAND
Provider First Name:
ANNE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609824051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 SW 257TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROUTDALE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97060-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-669-6800
Provider Business Mailing Address Fax Number:
503-491-1352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 SW 257TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROUTDALE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97060-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-669-6800
Provider Business Practice Location Address Fax Number:
503-491-2434
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD22396 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 287558 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 911768081 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 069013001 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150756 . This is a "WA LABOR & INDUSTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 911768081 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3004113-13 . This is a "BLUE CROSS HMO" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: ODS . This is a "911768081" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 7590294 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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