Provider Demographics
NPI:1477563203
Name:RICE, JOEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
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 1005
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1005
Mailing Address - Country:US
Mailing Address - Phone:541-963-0162
Mailing Address - Fax:541-962-0119
Practice Address - Street 1:1101 I AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2043
Practice Address - Country:US
Practice Address - Phone:541-963-0162
Practice Address - Fax:541-962-0119
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD181912084P0800X, 2084P0802X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR056569Medicaid
OR118114Medicare PIN
ORE35293Medicare UPIN