Provider Demographics
NPI:1366403404
Name:SUOJA, ERIC S (PAC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:SUOJA
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 E TUDOR RD
Mailing Address - Street 2:PMB 1168
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1185
Mailing Address - Country:US
Mailing Address - Phone:907-646-2559
Mailing Address - Fax:907-562-1319
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:STE. 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5222
Practice Address - Country:US
Practice Address - Phone:907-563-4006
Practice Address - Fax:907-646-2575
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK589363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK589OtherLICENSE
MS0897605OtherDEA
P80071Medicare UPIN
AKK152426Medicare ID - Type Unspecified