Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME85007 | FL |
NPI | 1053305565 |
---|---|
Provider Name | Dr. John Christian Southerland |
First Address | Sarasota, FL 34239-5142 |
Second Address | Sarasota, FL 34239-5142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 15/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H63652 | (02) | FL |