Provider Demographics
NPI:1336716562
Name:SUHLING, BLAKE ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:ANDREW
Last Name:SUHLING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 SUZANNE WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7418
Mailing Address - Country:US
Mailing Address - Phone:541-747-4300
Mailing Address - Fax:541-747-0655
Practice Address - Street 1:2644 SUZANNE WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7418
Practice Address - Country:US
Practice Address - Phone:541-747-4300
Practice Address - Fax:541-747-0655
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORPA206252363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program