Provider Demographics
NPI:1164459004
Name:RICE, LEE ROY (MD)
Entity Type:Individual
Prefix:
First Name:LEE ROY
Middle Name:
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:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:512-715-3364
Mailing Address - Fax:512-406-6505
Practice Address - Street 1:204 COUNTY ROAD 340A
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-4528
Practice Address - Country:US
Practice Address - Phone:512-715-3130
Practice Address - Fax:512-715-3131
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1247207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31875002Medicaid
TX8L13524Medicare PIN
C21046Medicare UPIN