Basic Information
| Provider Information | |||||||||
| NPI: | 1992890701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTHERLAND JR | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | PRATT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 NORTH CENTER ST | ||||||||
| Address2: | #800 | ||||||||
| City: | LEHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840437406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019901911 | ||||||||
| FaxNumber: | 8019901912 | ||||||||
| Practice Location | |||||||||
| Address1: | 8TH AVENUE AND C STREET | ||||||||
| Address2: | LSC HOSPITAL | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015075248 | ||||||||
| FaxNumber: | 8017335618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 10/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 159451-1205 | UT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 001204600 | 05 | ID | MEDICAID | 35935 | 01 | UT | DESERET MUTUAL | OTHER | QM0000075886 | 01 | UT | ALTIUS | OTHER | 2090168 | 01 | UT | UNITED HEALTHCARE | OTHER | 37825 | 01 | UT | PEHP | OTHER | 8597445 | 01 | UT | UMWA | OTHER | 870545614SU1 | 01 | UT | EDUCATORS MUTUAL | OTHER | 002084033 | 05 | NV | MEDICAID | 1502954 | 01 | UT | UMWA | OTHER | PRA02504 | 01 | UT | MOLINA | OTHER | 107006361101 | 01 | UT | IHC | OTHER | 107983200 | 05 | WY | MEDICAID | 820937 | 05 | AZ | MEDICAID | 53275 | 01 | UT | HEALTHY U | OTHER |