Provider Demographics
NPI:1053305565
Name:SOUTHERLAND, JOHN CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:SOUTHERLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 S TAMIAMI TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5142
Mailing Address - Country:US
Mailing Address - Phone:941-952-9223
Mailing Address - Fax:941-955-0642
Practice Address - Street 1:3325 S TAMIAMI TRL STE 200
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5142
Practice Address - Country:US
Practice Address - Phone:941-952-9223
Practice Address - Fax:941-955-0642
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85007207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13643ZOtherMEDICARE ID
FLME85007OtherME#
FLH63652Medicare UPIN