Provider Demographics
NPI:1699718783
Name:SUTHERLAND, DAVID (MD, PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 GOUGH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4425
Mailing Address - Country:US
Mailing Address - Phone:415-863-7000
Mailing Address - Fax:855-320-8143
Practice Address - Street 1:450 GOUGH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4425
Practice Address - Country:US
Practice Address - Phone:415-863-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA728742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72874OtherMEDICAL LICENSE
BS6939322OtherDEA LICENSE
H79954Medicare UPIN