Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | J7221 | TX |
Y | 208600000X | Surgeon | J7221 | TX |
NPI | 1023057353 |
---|---|
Provider Name | Mark Edward Sutherland |
First Address | Texarkana, TX 75503-3957 |
Second Address | Texarkana, TX 75503-3957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 26/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125618001 | (05) | AR |
159065501 | (05) | TX |
E96929 | (02) | TX |