Provider Demographics
NPI:1164606463
Name:RICE, PHILIP A (IDC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:A
Last Name:RICE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 788280
Mailing Address - Street 2:CLB-7 BAS
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92278-8280
Mailing Address - Country:US
Mailing Address - Phone:760-830-3750
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 2000 MCAGCC
Practice Address - Street 2:CLB-7 BAS
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8280
Practice Address - Country:US
Practice Address - Phone:760-830-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman