Healthcare Provider Details

I. General information

NPI: 1902874779
Provider Name (Legal Business Name): WILLIAM V IRBY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/07/2023
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CROSS ST
HAMILTON MO
64644-8311
US

IV. Provider business mailing address

2303 VILLAGE DR
SAINT JOSEPH MO
64506-4954
US

V. Phone/Fax

Practice location:
  • Phone: 816-583-2151
  • Fax:
Mailing address:
  • Phone: 816-307-4893
  • Fax: 816-232-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3G66
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: