Healthcare Provider Details

I. General information

NPI: 1982040168
Provider Name (Legal Business Name): RYAN DALLAS HANCOX D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E 13TH ST STE 1300
ERIE PA
16503-1035
US

IV. Provider business mailing address

153 E 13TH ST STE 1300
ERIE PA
16503-1035
US

V. Phone/Fax

Practice location:
  • Phone: 144-525-0818
  • Fax: 814-452-7918
Mailing address:
  • Phone: 814-452-5081
  • Fax: 814-452-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT015440
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS017496
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: