Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | E1247 | TX |
NPI | 1164459004 |
---|---|
Provider Name | Lee Roy Rice |
First Address | Burnet, TX 78611-7219 |
Second Address | Burnet, TX 78611-4528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 15/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31875002 | (05) | TX |
C21046 | (02) |