Provider Demographics
NPI:1083656136
Name:RICE, MATTHEW M (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:RICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:11315 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3004
Practice Address - Country:US
Practice Address - Phone:253-588-1711
Practice Address - Fax:253-581-6588
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288328Medicaid
WA0671RIOtherBSWA
WA8101479Medicaid
WA8196776Medicaid
ID000010141112OtherBSID
WARI0866OtherBSWA
ORP00002166Medicare PIN
WAP00392811Medicare PIN
OR131333Medicare PIN
WAE72517Medicare UPIN
OR288328Medicaid
WARI0866OtherBSWA
WA8101479Medicaid
ORR131328Medicare PIN
ID1107545Medicare PIN
WAG8850338Medicare PIN