Provider Demographics
NPI:1902874779
Name:IRBY, WILLIAM V (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:V
Last Name:IRBY
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 1:2303 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4954
Mailing Address - Country:US
Mailing Address - Phone:816-307-4893
Mailing Address - Fax:816-232-2991
Practice Address - Street 1:101 CROSS ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MO
Practice Address - Zip Code:64644-8311
Practice Address - Country:US
Practice Address - Phone:816-583-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3G66207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242356400Medicaid
B10854275OtherDEA
C51824Medicare UPIN
261818Medicare Oscar/Certification
B10854275OtherDEA
MO242356400Medicaid