Provider Demographics
NPI:1366529570
Name:ERRICO, WILLIAM RYAN (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RYAN
Last Name:ERRICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:RYAN
Other - Last Name:ERRICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:1337 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2046
Practice Address - Country:US
Practice Address - Phone:417-967-5435
Practice Address - Fax:417-967-5503
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002103207Q00000X
MO2022032258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0263251OtherWASHINGTON LABOR & INDUSTRIES
WA2008275Medicaid
MO200124350Medicaid
MO26D0889777OtherCLIA
MO26D0679044OtherCLIA