Provider Demographics
NPI:1992727234
Name:RILEY, WILLIAM DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4250 EAST CAMELBACK ROAD
Mailing Address - Street 2:SUITE K100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-8374
Mailing Address - Country:US
Mailing Address - Phone:602-224-9218
Mailing Address - Fax:602-224-0078
Practice Address - Street 1:4250 EAST CAMELBACK ROAD
Practice Address - Street 2:SUITE K100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8374
Practice Address - Country:US
Practice Address - Phone:602-224-9218
Practice Address - Fax:602-224-0078
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ22905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71308Medicare PIN