Provider Demographics
NPI:1417975178
Name:SUITER, JAMES G (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:SUITER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:74B CENTENNIAL LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7918
Mailing Address - Country:US
Mailing Address - Phone:541-393-0100
Mailing Address - Fax:541-393-0104
Practice Address - Street 1:74B CENTENNIAL LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7918
Practice Address - Country:US
Practice Address - Phone:541-393-0100
Practice Address - Fax:541-393-0104
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORPA00137363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S31025Medicare UPIN
R135501Medicare PIN