MEDICARE: WILLIAM RYAN MOULTRAY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OP00001888	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0411500	OTHER	WA	LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1528089695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM RYAN MOULTRAY DO

Provider Business Mailing Address
First Line	:	501 S 5TH AVE
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98902-3550
Country	:	US
Telephone Number	:	509-494-6700
Fax Number	:	509-573-6275

Provider Business Practice Location Address
First Line	:	102 E 2ND ST
Second Line	:
City	:	NACHES
State	:	WA
Zip	:	98937
Country	:	US
Telephone Number	:	509-653-2235
Fax Number	:	509-653-2236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	03/23/2020

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