Provider Demographics
NPI:1942247572
Name:MITCHELL, RALPH ALAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:ALAN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 315-J1-TRM
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:253-403-7537
Mailing Address - Fax:253-403-7539
Practice Address - Street 1:315 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:MS: 315-J1-TRM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4234
Practice Address - Country:US
Practice Address - Phone:253-403-7537
Practice Address - Fax:253-403-7539
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10003857363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8362220Medicaid
WA8362220Medicaid