Healthcare Provider Details

I. General information

NPI: 1558719468
Provider Name (Legal Business Name): RALPH ADAM PATTERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N 13TH W
SAINT JOHNS AZ
85936-4986
US

IV. Provider business mailing address

625 N 13TH W
SAINT JOHNS AZ
85936-4986
US

V. Phone/Fax

Practice location:
  • Phone: 928-337-3000
  • Fax: 928-532-3561
Mailing address:
  • Phone: 928-337-3000
  • Fax: 928-532-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58002
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: