Healthcare Provider Details

I. General information

NPI: 1366529570
Provider Name (Legal Business Name): WILLIAM RYAN ERRICO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BILL RYAN ERRICO D.O.

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 S SAM HOUSTON BLVD
HOUSTON MO
65483-2046
US

IV. Provider business mailing address

820 N CHELAN AVE
WENATCHEE WA
98801-2028
US

V. Phone/Fax

Practice location:
  • Phone: 417-967-5435
  • Fax: 417-967-5503
Mailing address:
  • Phone: 509-663-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00002103
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022032258
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: