Individual
MYLES JULIAN KETCHUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
2360 MENDOCINO AVE, SANTA ROSA, CA 95403-3153
(707) 573-5250
(707) 573-5458
Mailing address
PO BOX 276950, SACRAMENTO, CA 95827-6950
(707) 573-5250
(707) 573-5458
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
1211497
CA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
61-25999
CA
Other
Enumeration date
04/18/2017
Last updated
05/27/2025
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