Provider Demographics
NPI:1972519262
Name:RILEY, WILLIAM B JR (MDPA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:RILEY
Suffix:JR
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2450
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77512-2450
Mailing Address - Country:US
Mailing Address - Phone:281-703-0179
Mailing Address - Fax:
Practice Address - Street 1:17510 W GRAND PKWY STE 560
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2649
Practice Address - Country:US
Practice Address - Phone:281-725-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CB02Medicare PIN