=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982040168
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN DALLAS HANCOX D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2013
-----------------------------------------------------
Last Update Date | 04/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 153 E 13TH ST STE 1300
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16503-1035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 144-525-0818
-----------------------------------------------------
Fax | 814-452-7918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 153 E 13TH ST STE 1300
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16503-1035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-452-5081
-----------------------------------------------------
Fax | 814-452-7918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OT015440
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS017496
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------