Provider Demographics
NPI:1235800749
Name:PRYKA, EUGENE THOMAS (INDEPENDENT DUTY HS)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:THOMAS
Last Name:PRYKA
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500A SENTINEL ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6849
Mailing Address - Country:US
Mailing Address - Phone:602-570-8173
Mailing Address - Fax:
Practice Address - Street 1:500A SENTINEL ISLAND AVE
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6849
Practice Address - Country:US
Practice Address - Phone:602-570-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD03353518OtherTRICARE