Healthcare Provider Details

I. General information

NPI: 1043396484
Provider Name (Legal Business Name): WILLIAM J RILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-3276
  • Fax: 330-543-8489
Mailing address:
  • Phone: 409-772-3365
  • Fax: 409-747-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberJ5527
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: