Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO04185 | WY |
N | 222Z00000X | Podiatrist | CPO04185 | WY |
Y | 224P00000X | Prosthetist | CPO04185 | WY |
NPI | 1417591843 |
---|---|
Provider Name | Brodie Rice |
First Address | Gillette, WY 82716-4125 |
Second Address | Gillette, WY 82716-4125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2019 |
Last Update Date | 24/05/2021 |