Provider Demographics
NPI:1477133288
Name:RALPHS, ISAAC MICHEAL (PA-C)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:MICHEAL
Last Name:RALPHS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:IKE
Other - Middle Name:MIKE
Other - Last Name:RALPHS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:322 E GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-4610
Mailing Address - Country:US
Mailing Address - Phone:435-654-1377
Mailing Address - Fax:
Practice Address - Street 1:322 E GATEWAY DR
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4610
Practice Address - Country:US
Practice Address - Phone:435-654-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12943421-8906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12943421-1206OtherSTATE OF UTAH DEPARTMENT OF COMMERCE, DIVISION OF OCCUPATIONAL & PROFESSIONAL LI