Provider Demographics
NPI:1467664862
Name:RICE, STEPHEN EUGENE (IDC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EUGENE
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:USS RENTZ FFG-46
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96677 1500
Mailing Address - Country:US
Mailing Address - Phone:619-556-4270
Mailing Address - Fax:619-556-4625
Practice Address - Street 1:USS RENTZ FFG-46
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96677 1500
Practice Address - Country:US
Practice Address - Phone:619-556-4270
Practice Address - Fax:619-556-4625
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman