Healthcare Provider Details

I. General information

NPI: 1972444826
Provider Name (Legal Business Name): RAYMOND KETCHAM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6036 N 19TH AVE STE 503
PHOENIX AZ
85015-2143
US

IV. Provider business mailing address

6036 N 19TH AVE STE 503
PHOENIX AZ
85015-2143
US

V. Phone/Fax

Practice location:
  • Phone: 623-986-6834
  • Fax: 800-650-5831
Mailing address:
  • Phone: 623-986-6834
  • Fax: 800-650-5831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND KETCHAM
Title or Position: MEDICAL DIRECTOR
Credential: FNP-C
Phone: 623-986-6834