Provider Demographics
NPI:1982040168
Name:HANCOX, RYAN DALLAS (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DALLAS
Last Name:HANCOX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E 13TH ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16503-1035
Mailing Address - Country:US
Mailing Address - Phone:814-452-5081
Mailing Address - Fax:814-452-7918
Practice Address - Street 1:153 E 13TH ST STE 1300
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16503-1035
Practice Address - Country:US
Practice Address - Phone:144-525-0818
Practice Address - Fax:814-452-7918
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015440207Q00000X
PAOS017496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine